1073517058 NPI number — ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT

Table of content: (NPI 1073517058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073517058 NPI number — ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073517058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTALES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88130-0868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-359-1800
Provider Business Mailing Address Fax Number:
575-356-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42121 US HIGHWAY 70
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTALES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88130-9357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-359-1800
Provider Business Practice Location Address Fax Number:
575-356-9200
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOYER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
575-356-3416

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  3061 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 148185501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148185503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17678 . This is a "PRESBYTERIAN SALUD/HOSPIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: G8765 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8786 . This is a "MEDICAID/PHYSICIANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM007684 . This is a "BCBS/PHYSICIANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23587 . This is a "LOVELACE SALUD/HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM000077 . This is a "BCBS/HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148185502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23587 . This is a "LOVELACE SALUD/PHYSICIANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: G8465 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com