Provider Demographics
NPI:1336807254
Name:GALLUP COMMUNITY HEALTH
Entity Type:Organization
Organization Name:GALLUP COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VALORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-861-5767
Mailing Address - Street 1:2111 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5600
Mailing Address - Country:US
Mailing Address - Phone:505-397-5381
Mailing Address - Fax:
Practice Address - Street 1:1105 SUSAN AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4919
Practice Address - Country:US
Practice Address - Phone:206-861-5767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty