Basic Information
| Provider Information | |||||||||
| NPI: | 1366420747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIUNNO | ||||||||
| FirstName: | EILEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1337 | ||||||||
| Address2: | |||||||||
| City: | GALLUP | ||||||||
| State: | NM | ||||||||
| PostalCode: | 873051337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057221000 | ||||||||
| FaxNumber: | 5057221192 | ||||||||
| Practice Location | |||||||||
| Address1: | 516 E. NIZHONI BLVD | ||||||||
| Address2: | |||||||||
| City: | GALLUP | ||||||||
| State: | NM | ||||||||
| PostalCode: | 873011337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057221000 | ||||||||
| FaxNumber: | 5057221192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 85-140 | NM | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00049373 | 01 | RAILROAD MEDICARE | OTHER | 201000850 | 01 | NM | PRESBYTERIAN HEALTH/SALUD | OTHER | 85031326887301A099 | 01 | CHAMPUS | OTHER | 10002097 | 01 | NM | LOVELACE HEALTH/SALUD | OTHER | R6765 | 05 | NM | MEDICAID | 413328 | 01 | AZ | AHCCCS | OTHER | NM011561 | 01 | NM | BC/BS | OTHER |