1427051002 NPI number — CLAYTON HEALTH SYSTEMS INC

Table of content: (NPI 1427051002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427051002 NPI number — CLAYTON HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAYTON HEALTH SYSTEMS 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:
UNION COUNTY GENERAL 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:
1427051002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 489
Provider Second Line Business Mailing Address:
300 WILSON STREET
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88415-0489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-374-2585
Provider Business Mailing Address Fax Number:
575-374-8146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 WILSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88415-0489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-374-2585
Provider Business Practice Location Address Fax Number:
575-374-8146
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BATTEN
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIR REVENUE
Authorized Official Telephone Number:
575-374-9014

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  3060 , 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: 0080 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: K5719 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: M1715 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: B2253 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201079753 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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