Provider Demographics
NPI:1871630665
Name:MINERS COLFAX MEDICAL CENTER
Entity Type:Organization
Organization Name:MINERS COLFAX MEDICAL CENTER
Other - Org Name:MIINERS COLFAX MEDICAL CENTER LTC NURSING FACILITY
Other - Org Type:Other Name
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:575-445-3661
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2013
Mailing Address - Country:US
Mailing Address - Phone:505-445-3661
Mailing Address - Fax:505-445-4518
Practice Address - Street 1:900 S 6TH ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4224
Practice Address - Country:US
Practice Address - Phone:505-445-4518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINERS COLFAX MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5083313M00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI0472Medicaid