Provider Demographics
NPI:1073517058
Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Other - Org Name:ROOSEVELT GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-356-3416
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0868
Mailing Address - Country:US
Mailing Address - Phone:575-359-1800
Mailing Address - Fax:575-356-9200
Practice Address - Street 1:42121 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9357
Practice Address - Country:US
Practice Address - Phone:575-359-1800
Practice Address - Fax:575-356-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3061282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148185501Medicaid
TX148185503Medicaid
17678OtherPRESBYTERIAN SALUD/HOSPIT
NMG8765Medicaid
G8786OtherMEDICAID/PHYSICIANS
NM007684OtherBCBS/PHYSICIANS
23587OtherLOVELACE SALUD/HOSPITAL
NM000077OtherBCBS/HOSPITAL
TX148185502Medicaid
23587OtherLOVELACE SALUD/PHYSICIANS
NMG8465Medicaid
NM000077OtherBCBS/HOSPITAL
TX148185502Medicaid
NMG8465Medicaid
23587OtherLOVELACE SALUD/HOSPITAL
NM007684OtherBCBS/PHYSICIANS