TEDOMER LLC (NPI# 1033394861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033394861 |
| Entity Type | Organization |
| Organization Name | TEDOMER LLC |
| Practice Address |
3720 Church Rock Rd Gallup NM 87301-4572 |
| Practice Telephone | 5057222261 |
| Practice Fax Number | 5057224732 |
| Mailing Telephone | 5057222261 |
| Mailing Fax Number | 5057224732 |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2008-01-03 |
| Authorized Official Name | TIMOTHY NMN DOMER (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 5057834045 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207QH0002X |
Family Medicine Specialization: Hospice and Palliative Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
3720 CHURCH ROCK RD |
| City | GALLUP |
| State | NM |
| Zip Code | 87301-4572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154966141 | Karen Marie Acuesta Arboleda | Registered Nurse | 516 E Nizhoni Bld., Gallup, NM 87301 | 2019-11-13 |
| 1811453707 | Kelly Dahn | Respiratory Therapist, Certified | 516 E Hizhoni Blvd, Gallup, NM 87301 | 2019-02-15 |
| 1417411232 | Frances Griego | Registered Nurse | 28b Alma Drive, Gallup, NM 87301 | 2019-01-25 |
| 1891267605 | Hozho Academy | Occupational Therapist | 306 Nm-564, Gallup, NM 87301 | 2018-12-19 |
| 1922514686 | Jjdac, LLC | Ambulance | 208 W Maloney Ave, Gallup, NM 87301 | 2017-12-18 |
| 1508382698 | Katherine L Kuehl | Pharmacist | Walgreens 1870 E Historic Highway 66, Galliup, NM 87301 | 2017-08-21 |
| 1497285001 | Jessica Kate Savant | Registered Nurse | 516 E Nazhoni Blvd, Gallup, NM 87301 | 2017-06-15 |
| 1770013385 | Nicole Aline Pavy | Registered Nurse | 516 E. Nizhioni Blvd, Gallup, NM 87301 | 2017-06-15 |
| 1730612276 | Camie Renee Nelson | Contractor | 121 Bishop Drive, Gallup, NM 87301 | 2017-04-11 |
| 1508216227 | Marriah Silversmith | Technician, Other | 3426 Blue Hill Ave, Gallup, NM 87301 | 2016-06-14 |
| Find all providers in zip 87301 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639352834 | Harsha Umesh | Internal Medicine | 1407 Redrock Dr, Gallup, NM 87301-5647 | 2007-12-11 |
| 1427123066 | Leanna Marie Hoffman | Internal Medicine | 520 Nm Highway 564, Gallup, NM 87301-4873 | 2006-11-21 |
| 1225410939 | Julia Noelle Beamesderfer | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301-5748 | 2015-06-18 |
| 1306224753 | Haley Thun | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301-5748 | 2015-05-18 |
| 1154748069 | Braden Mogler | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301 | 2014-03-28 |
| 1699111237 | Benjamin Daniel Johnson | Internal Medicine | 516 E. Nizhoni Blvd., Gallup, NM 87301-5748 | 2013-05-21 |
| 1851734461 | Jennifer Michelle Bass | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301-5748 | 2013-04-12 |
| 1780943894 | Duncan Randolph White | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301-5748 | 2012-05-09 |
| 1396047908 | Elizabeth Ann Ketner | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301-5748 | 2010-12-02 |
| 1588981633 | Kelvin K. Chan | Internal Medicine | 516 E Nizhoni Blvd, Gallup, NM 87301-5748 | 2010-04-29 |
| Find all providers in GALLUP | ||||
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| 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.