Kewa Pueblo Health Corporation
NPI #1467739888 in Santo Domingo Pueblo, New Mexico
Provider Information
- NPI Number
- 1467739888
- Entity Type
- Organization
- Organization Name
- Kewa Pueblo Health Corporation
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- KEWA PUEBLO HEALTH CORPORATION
- Primary Specialty
- Clinic/Center - Federally Qualified Health Center (FQHC)
- Enumeration Date
- Nov 14, 2011
- Last Updated
- Feb 22, 2024
Practice Location
- Address
- 85 W HIGHWAY 22
- State
- New Mexico
- ZIP Code
- 87052-0559
- Phone
- (505) 465-3060
Authorized Official
- Name
- JIMMIE R CHARLIE, MD
- Title
- CHIEF MEDICAL OFFICER
- Phone
- (505) 465-3060
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
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