Provider Demographics
NPI:1497843734
Name:ZUNI INDIAN HOSPITAL
Entity Type:Organization
Organization Name:ZUNI INDIAN HOSPITAL
Other - Org Name:ZUNI INDIAN HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTHOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-782-7300
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0467
Mailing Address - Country:US
Mailing Address - Phone:505-782-4431
Mailing Address - Fax:505-782-7327
Practice Address - Street 1:ROUTE 301 NORTH B STREET
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327-0000
Practice Address - Country:US
Practice Address - Phone:505-782-4431
Practice Address - Fax:505-782-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMHSZ061Medicare PIN
NM320060Medicare Oscar/Certification