Provider Demographics
NPI:1346780434
Name:MINERS COLFAX MEDICAL CENTER
Entity Type:Organization
Organization Name:MINERS COLFAX MEDICAL CENTER
Other - Org Name:MINERS COLFAX MEDICAL CENTER RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-445-7722
Mailing Address - Street 1:203 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2012
Mailing Address - Country:US
Mailing Address - Phone:575-445-3661
Mailing Address - Fax:575-445-7743
Practice Address - Street 1:203 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2012
Practice Address - Country:US
Practice Address - Phone:575-445-3661
Practice Address - Fax:575-445-7743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINERS COLFAX MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-08
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3551261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45079277Medicaid