Provider Demographics
NPI:1801365317
Name:SIERRA VISTA HOSPITAL 69
Entity type:Organization
Organization Name:SIERRA VISTA HOSPITAL 69
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ANNE
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:T OR C
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1954
Mailing Address - Country:US
Mailing Address - Phone:575-743-1244
Mailing Address - Fax:575-894-7659
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:575-743-1244
Practice Address - Fax:575-894-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39804577Medicaid