| Organization Name: | NEW MEXICO MOUNTAIN HEALTHCARE |
| NPI Number: | 1508021627 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK G DUMAL (CEO) |
| Mailing Address: | 348 St. Rd. 4 San Ysidro |
| State: | NM US |
| Postal Code: | 87053 |
| Phone Number: | 5054046048 |
| Fax Number: | |
| NPI Enumeration Date: | 07/29/2008 |
| NPI Last Update Date: | 07/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 97-229 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |