1427051002 NPI number — CLAYTON HEALTH SYSTEMS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427051002 NPI number — CLAYTON HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAYTON HEALTH SYSTEMS INC
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:
UNION COUNTY GENERAL HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1427051002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 489
Provider Second Line Business Mailing Address:
300 WILSON STREET
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88415-0489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-374-2585
Provider Business Mailing Address Fax Number:
575-374-8146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 WILSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88415-0489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-374-2585
Provider Business Practice Location Address Fax Number:
575-374-8146
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BATTEN
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIR REVENUE
Authorized Official Telephone Number:
575-374-9014

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  3060 , 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: 0080 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: K5719 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: M1715 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: B2253 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201079753 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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