1548315864 NPI number — ENMU-ROSWELL SCHOOL BASED HEALTH CENTER

Table of content: (NPI 1548315864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548315864 NPI number — ENMU-ROSWELL SCHOOL BASED HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENMU-ROSWELL SCHOOL BASED HEALTH CENTER
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:
1548315864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6000
Provider Second Line Business Mailing Address:
ATTN JANE BATSON SBHC
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88202-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-627-2808
Provider Business Mailing Address Fax Number:
505-624-2290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E BLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88203-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-627-2808
Provider Business Practice Location Address Fax Number:
505-624-2290
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEARING
Authorized Official First Name:
JENEVA
Authorized Official Middle Name:
JEWEL
Authorized Official Title or Position:
HEALTH COORDINATOR
Authorized Official Telephone Number:
505-627-2808

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9A01 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com