Provider Demographics
NPI:1215005129
Name:PHC-LOS ALAMOS INC
Entity Type:Organization
Organization Name:PHC-LOS ALAMOS INC
Other - Org Name:LOS ALAMOS MEDICAL CENTER - SWING BED UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-662-4201
Practice Address - Fax:505-661-9598
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHC-LOS ALAMOS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32U033Medicare Oscar/Certification