Provider Demographics
NPI:1063812089
Name:GALLUP QUICK CLINIC PC
Entity type:Organization
Organization Name:GALLUP QUICK CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-327-4867
Mailing Address - Street 1:1850 E HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4955
Mailing Address - Country:US
Mailing Address - Phone:505-722-9334
Mailing Address - Fax:505-722-9352
Practice Address - Street 1:1850 E HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4955
Practice Address - Country:US
Practice Address - Phone:505-722-9334
Practice Address - Fax:505-722-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care