Provider Demographics
NPI:1225161474
Name:ROSWELL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:ROSWELL HOSPITAL CORPORATION
Other - Org Name:VALLEY HEALTH CLINIC OF EASTERN NEW MEXICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:116 EAST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NM
Mailing Address - Zip Code:88230
Mailing Address - Country:US
Mailing Address - Phone:505-734-5817
Mailing Address - Fax:
Practice Address - Street 1:116 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NM
Practice Address - Zip Code:88230
Practice Address - Country:US
Practice Address - Phone:505-734-5817
Practice Address - Fax:505-734-6550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSWELL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6687261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS3929Medicaid
NMS3929Medicaid