1578639662 NPI number — ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT

Table of content: (NPI 1578639662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578639662 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:
N/A
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:
1578639662
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 299
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:
88130-0299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-356-6652
Provider Business Mailing Address Fax Number:
575-359-6827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 W 21ST ST STE R1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88101-4098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-935-0944
Provider Business Practice Location Address Fax Number:
575-935-0948
Provider Enumeration Date:
11/28/2006

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: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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