Provider Demographics
NPI:1437570728
Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Other - Org Name:RGH ANESTHESIA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-356-3412
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0568
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:42121 U.S. 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9054
Practice Address - Country:US
Practice Address - Phone:575-359-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty