Provider Demographics
NPI:1578639662
Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-356-3416
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0299
Mailing Address - Country:US
Mailing Address - Phone:575-356-6652
Mailing Address - Fax:575-359-6827
Practice Address - Street 1:2000 W 21ST ST STE R1
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4098
Practice Address - Country:US
Practice Address - Phone:575-935-0944
Practice Address - Fax:575-935-0948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health