Provider Demographics
NPI:1386040525
Name:SHIPROCK CLINIC
Entity Type:Organization
Organization Name:SHIPROCK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-368-2560
Mailing Address - Street 1:PO BOX 2662
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-2662
Mailing Address - Country:US
Mailing Address - Phone:505-368-2560
Mailing Address - Fax:505-368-2561
Practice Address - Street 1:1 MI E SAN JUAN RIVER BRIDGE US HWY 64
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-2560
Practice Address - Fax:505-368-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care