Provider Demographics
NPI:1336220839
Name:GILA REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GILA REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-538-4115
Mailing Address - Street 1:1313 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7251
Mailing Address - Country:US
Mailing Address - Phone:575-538-4000
Mailing Address - Fax:505-538-2824
Practice Address - Street 1:1313 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-538-4000
Practice Address - Fax:575-538-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6095282N00000X, 3416L0300X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS173IPMedicaid
NM00570Medicaid
KY01500180Medicaid
AZ026585Medicaid
MN135218100Medicaid
LA1761869Medicaid
NM00NM00057OtherBCBS NEW MEXICO
KS200267710AMedicaid
IN200495290AMedicaid
AR149132105Medicaid
CO27884384Medicaid
GA574159201AMedicaid
FL9017615-00Medicaid
CAXHSP40517Medicaid
CAXHSP30517Medicaid
IA0719773Medicaid
ALGIL0016NMedicaid
AKHS173OPMedicaid
AZ026585Medicaid