1881665594 NPI number — DEMING HOSPITAL CORPORATION

Table of content: (NPI 1881665594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881665594 NPI number — DEMING HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEMING HOSPITAL CORPORATION
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:
MIMBRES MEMORIAL 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:
1881665594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 844814
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-4814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMING
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88030-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-546-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PORTACCI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP, GROUP OPERATIONS
Authorized Official Telephone Number:
888-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  6552 , 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: 21486 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0023 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00B2113 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022426 . This is a "AHCCCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM000023 . This is a "OUT OF STATE BCBS" identifier . This identifiers is of the category "OTHER".




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