KEWA PUEBLO HEALTH CORPORATION NPI 1467739888

NPI Information

NPI: 1467739888
Provider Name: KEWA PUEBLO HEALTH CORPORATION
Classification: Clinic/Center - 261QF0400X
Specialization: Federally Qualified Health Center (FQHC)
Entity Type: Organization
Other Name: SANTO DOMINGO HEALTH CENTER
CLIA Number: 32D0907625
Address: 85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM
ZIP 87052
Phone: (505) 465-3060

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NPI Details

KEWA PUEBLO HEALTH CORPORATION is a federally qualified health center (fqhc) clinic center in Santo Domingo Pueblo, NM. KEWA PUEBLO HEALTH CORPORATION NPI is 1467739888. The provider is registered as an organization entity type.
The provider Other Name Is Santo Domingo Health Center.

The provider's business location address is:

85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM
ZIP 87052-559
Phone: (505) 465-3060
Fax: (505) 465-1191

The provider's authorized official is Jimmie R Charlie .
The authorized official title is Chief Medical Officer and has the following contact phone number (505) 465-3060.

The CLIA number assigned to this NPI record is 32D0907625 - rural health clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/14/2011 and was last updated on 2/22/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center		03217726007	NEW MEXICO	No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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