1235132820 NPI number — SIERRA HEALTH CARE 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 1235132820 NPI number — SIERRA HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA HEALTH CARE 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:
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:
1235132820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N SILVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUTH OR CONSEQUENCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87901-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-894-7855
Provider Business Mailing Address Fax Number:
575-894-6438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 N SILVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUTH OR CONSEQUENCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87901-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-894-7855
Provider Business Practice Location Address Fax Number:
575-894-6438
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JEREMY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
575-894-7855

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  01178319002 , 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: I-0555 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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