Provider Demographics
NPI:1679811046
Name:NMU-ROSWELL ROSWELL HIGH SCHOOL SBHC
Entity Type:Organization
Organization Name:NMU-ROSWELL ROSWELL HIGH SCHOOL SBHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. VP FOR EXTERNAL AFFAIRS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:575-624-7233
Mailing Address - Street 1:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-6000
Mailing Address - Country:US
Mailing Address - Phone:575-624-7000
Mailing Address - Fax:575-624-7100
Practice Address - Street 1:500 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-1834
Practice Address - Country:US
Practice Address - Phone:575-627-2808
Practice Address - Fax:575-624-7100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENMU-ROSWELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-19
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91674361Medicaid