Healthcare Provider Details

I. General information

NPI: 1487470977
Provider Name (Legal Business Name): SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FIVE SPRINGS RD.
ANGEL FIRE NM
87710
US

IV. Provider business mailing address

PO BOX 133
ANGEL FIRE NM
87710-0133
US

V. Phone/Fax

Practice location:
  • Phone: 575-377-3301
  • Fax:
Mailing address:
  • Phone: 575-377-3301
  • Fax: 575-377-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY DEHERRERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-483-3301