1114960093 NPI number — DHHS PHS NAIHS CROWNPOINT HOSPITAL

Table of content: DR. NIMAL JOE PONNEZHAN M.D. (NPI 1083975650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114960093 NPI number — DHHS PHS NAIHS CROWNPOINT HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS PHS NAIHS CROWNPOINT HOSPITAL
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:
1114960093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWNPOINT
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87313-0358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-786-5291
Provider Business Mailing Address Fax Number:
505-786-6440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JUNCTION OF HWY 371
Provider Second Line Business Practice Location Address:
NAVAJO RT9
Provider Business Practice Location Address City Name:
CROWNPOINT
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87313-0358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-786-5291
Provider Business Practice Location Address Fax Number:
505-786-6440
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROANHORSE
Authorized Official First Name:
ANSLEM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
505-786-5291

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: H8906 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32U062 . This is a "MEDICARE SWINGBED" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: HSZ143 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com