Provider Demographics
NPI:1114960093
Name:DHHS PHS NAIHS CROWNPOINT HOSPITAL
Entity Type:Organization
Organization Name:DHHS PHS NAIHS CROWNPOINT HOSPITAL
Other - Org Name:CROWNPOINT IHS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANSLEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROANHORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-786-5291
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-0358
Mailing Address - Country:US
Mailing Address - Phone:505-786-5291
Mailing Address - Fax:505-786-6440
Practice Address - Street 1:JUNCTION OF HWY 371
Practice Address - Street 2:NAVAJO RT9
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313-0358
Practice Address - Country:US
Practice Address - Phone:505-786-5291
Practice Address - Fax:505-786-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH8906Medicaid
NM32U062OtherMEDICARE SWINGBED
NMHSZ143OtherMEDICARE GROUP PTAN
NMH8906Medicaid