Provider Demographics
NPI:1336220839
Name:GILA REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:GILA REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-538-4000
Mailing Address - Street 1:1313 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7251
Mailing Address - Country:US
Mailing Address - Phone:575-538-4000
Mailing Address - Fax:505-538-2824
Practice Address - Street 1:3202 N. RIDGE LOOP
Practice Address - Street 2:SILVER CITY,
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-8806
Practice Address - Country:US
Practice Address - Phone:575-388-9708
Practice Address - Fax:575-342-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 282NC0060X
NM6095282N00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251E00000XAgenciesHome Health
No282N00000XHospitalsGeneral Acute Care Hospital
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS173IPMedicaid
IA0719773Medicaid
KS200267710AMedicaid
ALGIL0016NMedicaid
AZ026585Medicaid
MN135218100Medicaid
AKHS173OPMedicaid
NM00NM00057OtherBCBS NEW MEXICO
GA574159201AMedicaid
FL9017615-00Medicaid
NM00570Medicaid
AR149132105Medicaid
IN200495290AMedicaid
CO27884384Medicaid
CAXHSP30517Medicaid
LA1761869Medicaid
CAXHSP40517Medicaid
KY01500180Medicaid
AZ026585Medicaid