Provider Demographics
NPI:1528174851
Name:HATCH AREA MEDICAL CENTER FOUNDATION
Entity type:Organization
Organization Name:HATCH AREA MEDICAL CENTER FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:GARAY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-267-3088
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937
Mailing Address - Country:US
Mailing Address - Phone:505-267-0221
Mailing Address - Fax:505-267-0224
Practice Address - Street 1:251 HIGHWAY 187
Practice Address - Street 2:
Practice Address - City:HATCH
Practice Address - State:NM
Practice Address - Zip Code:87937
Practice Address - Country:US
Practice Address - Phone:505-267-0221
Practice Address - Fax:505-267-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCL000000493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR1280Medicaid
00NM00R034OtherBCBS OF NM