1861450579 NPI number — OTERO COUNTY HOSPITAL ASSOCIATION

Table of content: (NPI 1861450579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861450579 NPI number — OTERO COUNTY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OTERO COUNTY HOSPITAL ASSOCIATION
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:
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:
1861450579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2669 SCENIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88310-8700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-439-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2669 SCENIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-443-7403
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HECKERT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
575-443-7845

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  6016 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 6016 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 6016 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 21959838 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32S004 . This is a "GEROPSYCH" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 45930 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32U004 . This is a "SWING BED" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 91753821 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000018 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32T004 . This is a "INPATIENT REHAB" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: C84086 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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