KEWA PUEBLO HEALTH CORPORATION (NPI# 1003193251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003193251 |
| Entity Type | Organization |
| Organization Name | KEWA PUEBLO HEALTH CORPORATION |
| Other Organization Name | SANTO DOMINGO HEALTH CENTER |
| Practice Address |
85 W Highway 22 Santo Domingo NM 87052-0340 |
| Mailing Address |
Po Box 559 Santo Domingo Pueblo NM 87052-0559 |
| Practice Telephone | 5054653060 |
| Practice Fax Number | 5054651191 |
| Mailing Telephone | 5054653060 |
| Mailing Fax Number | 5054651191 |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |
| Authorized Official Name | VANESSA DIANA VIGIL (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 5054653060 |
| Is Organization Subpart | Y |
| Parent Organization Name | KEWA PUEBLO HEALTH CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Santo Domingo Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467739888 | Kewa Pueblo Health Corporation | Clinic/Center | 85 W Highway 22, Santo Domingo Pueblo, NM 87052-0559 | 2011-11-14 |
| 1336659077 | Kewa Pueblo Health Corporation | Community/Behavioral Health | 85 West Highway 22, Santo Domingo Pueblo, NM 87052 | 2017-10-09 |
| 1679842983 | Kewa Pueblo Health Corporation | Non-emergency Medical Transport (VAN) | 85 W Highway 22, Santo Domingo, NM 87052 | 2011-12-16 |
| 1902183155 | Kewa Pueblo Health Corporation | Clinic/Center | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1811274061 | Kewa Pueblo Health Corporation | Clinical Medical Laboratory | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1194002345 | Kewa Pueblo Health Corporation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1558648709 | Kewa Pueblo Health Corporation | Clinic/Center | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1467739615 | Kewa Pueblo Health Corporation | Optometrist | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| Street Address |
85 W HIGHWAY 22 |
| City | SANTO DOMINGO |
| State | NM |
| Zip Code | 87052-0340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679842983 | Kewa Pueblo Health Corporation | Non-emergency Medical Transport (VAN) | 85 W Highway 22, Santo Domingo, NM 87052 | 2011-12-16 |
| 1902183155 | Kewa Pueblo Health Corporation | Clinic/Center | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1811274061 | Kewa Pueblo Health Corporation | Clinical Medical Laboratory | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1194002345 | Kewa Pueblo Health Corporation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1558648709 | Kewa Pueblo Health Corporation | Clinic/Center | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1467739615 | Kewa Pueblo Health Corporation | Optometrist | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902353972 | Karin Luzzi | Registered Nurse | 100 Highway 22 W, Santo Domingo, NM 87052 | 2016-09-07 |
| 1043676273 | Kyle Maestas | Physician Assistant | 85 West Hwy 22, Santo Domingo, NM 87052 | 2016-01-04 |
| 1639579352 | Cynthia Brooks | Registered Nurse | 85 West Highway 22 Santo Domingo Health Center, Santo Domingo, NM 87052 | 2014-08-29 |
| 1720335219 | Samantha Nicole Torres | Pharmacist | 85 W Hwy 22, Santo Domingo, NM 87052 | 2012-08-14 |
| 1780835504 | Roger L Leonard | Clinic/Center | #85 West Hwy 22, Santo Domingo, NM 87052 | 2008-10-10 |
| 1679766489 | Santo Domingo Tribe | Ambulance | #1 Tesuque St., Ems Headquarters, Santo Domingo Pueblo, NM 87052 | 2007-08-24 |
| 1326165994 | Santa Domingo Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 340 San Ildefonso St, Santa Domingo, NM 87052 | 2007-03-26 |
| 1467509612 | Andrea Heeter | Specialist/Technologist | Santo Domingo Health Center, 85 Hwy 22, Santo Domingo, NM 87052 | 2007-01-03 |
| 1164531950 | Jonathan Neil Trujillo | Pharmacist | 85 West Highway 22, Santo Domingo Health Center, Santo Domingo, NM 87052 | 2006-08-29 |
| 1053920520 | John Patirck Pagett | Registered Nurse | 85 West Highway 22, Santo Domingo Pueblo, NM 87052 | 2020-07-30 |
| Find all providers in zip 87052 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358762 | Raton Family Dental LLC | Clinic/Center | 1100 S 2nd St Ste C, Raton, NM 87740-2326 | 2020-02-21 |
| 1700362589 | Morningstar Family Dental, LLC | Clinic/Center | 1005 Main St Sw, Los Lunas, NM 87031-8310 | 2018-07-16 |
| 1124512488 | Stacey Montano Dds LLC | Clinic/Center | 3901 Georgia St Ne Ste G1, Albuquerque, NM 87110-1388 | 2018-06-20 |
| 1003300393 | Napa Dental Management, LLC | Clinic/Center | 10820 Comanche Rd Ne Ste D, Albuquerque, NM 87111-3983 | 2018-06-19 |
| 1396243390 | Las Brisas Enterprises, LLC | Clinic/Center | 1209 Bonita Ave Suite A, Grants, NM 87020 | 2018-01-25 |
| 1780195024 | Devin Giron, Dds | Clinic/Center | 2 Calle Medico Ste 3, Santa Fe, NM 87505-4785 | 2017-10-13 |
| 1679017453 | Embudo Dental Center LLC | Clinic/Center | 1102 State Highway 68, Embudo, NM 87531-0037 | 2016-12-13 |
| 1871042457 | Dental House Trade Winds, LLC | Clinic/Center | 5400 Central Ave Se, Suite C-101, Albuquerque, NM 87108-1502 | 2016-09-24 |
| 1336505916 | Clovis Family Dentistry, LLC | Clinic/Center | 2000 W 21st St Ste L1, Clovis, NM 88101-1400 | 2016-01-12 |
| 1528437258 | Anywhere Dental Care | Clinic/Center | 28 Canada De Los Alamos Trl Se, Albuquerque, NM 87123-9504 | 2015-09-23 |
| Find all providers with the same taxonomy | ||||
| City | SANTO DOMINGO |
| Zip Code | 87052 |
Please comment or provide details below to improve the information on KEWA PUEBLO HEALTH CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.