Provider Demographics
NPI:1689638942
Name:SIERRA VISTA HOSPITAL 69
Entity Type:Organization
Organization Name:SIERRA VISTA HOSPITAL 69
Other - Org Name:SIERRA VISTA COMMUNITY HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-894-2111
Mailing Address - Street 1:800 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1954
Mailing Address - Country:US
Mailing Address - Phone:505-894-2111
Mailing Address - Fax:505-894-7659
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:505-894-2111
Practice Address - Fax:505-894-7659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA VISTA HOSPITAL 69
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39804577Medicaid
323999Medicare Oscar/Certification