Provider Demographics
NPI:1235219742
Name:CLAYTON HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:CLAYTON HEALTH SYSTEMS INC
Other - Org Name:CLAYTON HEALTH SYSTEMS MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-374-2585
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415-0489
Mailing Address - Country:US
Mailing Address - Phone:575-374-0112
Mailing Address - Fax:575-374-0117
Practice Address - Street 1:300 WILSON ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415-3304
Practice Address - Country:US
Practice Address - Phone:575-374-2585
Practice Address - Fax:575-374-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4931920001Medicare PIN