Provider Demographics
NPI:1073138244
Name:HASTAADI NEEZNADIIN DBA: GALLUP HEALTH
Entity type:Organization
Organization Name:HASTAADI NEEZNADIIN DBA: GALLUP HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BURGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-726-7642
Mailing Address - Street 1:1108 E HISTORIC HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5466
Mailing Address - Country:US
Mailing Address - Phone:505-726-9642
Mailing Address - Fax:505-726-9642
Practice Address - Street 1:1108 E HISTORIC HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5466
Practice Address - Country:US
Practice Address - Phone:505-726-9642
Practice Address - Fax:505-726-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91159792Medicaid
AZ210425Medicaid