Healthcare Provider Details

I. General information

NPI: 1114304136
Provider Name (Legal Business Name): ARTESIA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W PIERCE ST
CARLSBAD NM
88220-4014
US

IV. Provider business mailing address

702 N 13TH ST
ARTESIA NM
88210-1166
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5562
  • Fax:
Mailing address:
  • Phone: 575-736-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH RANDALL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 575-736-8116