Provider Demographics
NPI:1265959506
Name:SIERRA VISTA HOSPITAL 69
Entity type:Organization
Organization Name:SIERRA VISTA HOSPITAL 69
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-743-1244
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:575-894-3221
Mailing Address - Fax:
Practice Address - Street 1:600 BUTTE BLVD
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935
Practice Address - Country:US
Practice Address - Phone:575-894-3221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA VISTA HOSPITAL 69
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty