PUEBLO OF SAN FELIPE (NPI# 1467550475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467550475 |
| Entity Type | Organization |
| Organization Name | PUEBLO OF SAN FELIPE |
| Other Organization Name | SAN FELIPE HEALTH CLINIC PHCY |
| Practice Address |
3 Cedar St San Felipe Pueblo San Felipe NM 87001 |
| Mailing Address |
Po Box 4342 Po Box 4339 San Felipe NM 87001 |
| Practice Telephone | 5058675485 |
| Practice Fax Number | 5057719940 |
| Mailing Telephone | 5058679616 |
| Mailing Fax Number | 5057719940 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2018-06-11 |
| Authorized Official Name | DARYL CANDELARIA (TRIBAL ADMIN) |
| Authorized Official Telephone | 5058673381 |
| Authorized Official Credential | PHARMD RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2058717 | 01 | |
| NM | 81271875 | 05 |
| Other Name | Type Code |
|---|---|
| SAN FELIPE HEALTH CLINIC PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265511299 | Pueblo of San Felipe | Clinic/Center | 3 Cedar Rd., San Felipe, NM 87001 | 2006-11-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PUEBLO OF SAN FELIPE | 127 Hagon Rd, San Felipe Pb, NM 87001-8087 |
| Street Address |
3 CEDAR ST SAN FELIPE PUEBLO |
| City | SAN FELIPE |
| State | NM |
| Zip Code | 87001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740751841 | Edward Gary Gum | Registered Nurse | #3 Cedar Road, San Felipe Pueblo, NM 87001 | 2018-12-16 |
| 1194229278 | Michael Townsend | Peer Specialist | 3 Cedar Rd, Algodones, NM 87001 | 2018-03-22 |
| 1750837332 | Kaitlyn Therese Archibeque | Specialist/Technologist | 1370a Hwy 313, Algodones, NM 87001 | 2016-09-01 |
| 1992154850 | Tonya Louis | Social Worker | 25 Cougar Road, San Felipe, NM 87001 | 2016-06-10 |
| 1821391806 | Gail Aguilar | Counselor | 18 Cougar Road, San Felipe Behavioral Health Program, San Felipe, NM 87001 | 2010-12-13 |
| 1740341304 | David M Hanson | Dentist | #4 Cedar Street, San Felipe, NM 87001 | 2006-12-13 |
| 1265511299 | Pueblo of San Felipe | Clinic/Center | 3 Cedar Rd., San Felipe, NM 87001 | 2006-11-02 |
| 1831274851 | San Felipe Health Clinic | General Acute Care Hospital | Cedar Street, San Felipe, NM 87001 | 2006-10-26 |
| 1164439261 | Marvin Jordan Godner | Pediatrics | 711 Pueblo Main Street, San Felipe Pueblo, NM 87001 | 2006-08-02 |
| 1366425712 | Julie Anna King | Pharmacist | San Felipe Health Clinic Pharmacy, Cedar Street #4 San Felipe Pueblo, San Felipe, NM 87001 | 2005-11-21 |
| Find all providers in zip 87001 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629525605 | Canoncito Band of Navajos Health Center, Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 129 Medicine Horse Road, Canoncito, NM 87026 | 2016-09-07 |
| 1326165994 | Santa Domingo Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 340 San Ildefonso St, Santa Domingo, NM 87052 | 2007-03-26 |
| 1225155666 | Zia Indian Health Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 155b Capitol Square Dr, San Ysidro, NM 87053-6013 | 2007-03-22 |
| 1154453413 | Santa Ana Health Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 02 C Dove Rd, Bernalillo, NM 87004 | 2007-03-12 |
| 1023148608 | Crownpoint Health Care Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Hwy Jct 57 Rt 9, Crownpoint, NM 87313-0358 | 2007-03-06 |
| 1750425484 | Mescalero Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 318 Abalonie Loop, Mescalero, NM 88340 | 2007-02-16 |
| 1073671194 | Pine Hill Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Bia Rt 125, Pine Hill, NM 87357 | 2006-12-04 |
| 1609116573 | Pueblo of Sandia | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 203 Sandia Day School Road, Bernalillo, NM 87004-7076 | 2013-02-28 |
| 1194002345 | Kewa Pueblo Health Corporation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1124220900 | Jicarilla Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 12000 Stone Lake Rd, Dulce, NM 87528 | 2007-06-04 |
| Find all providers with the same taxonomy | ||||
| City | SAN FELIPE |
| Zip Code | 87001 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.