Healthcare Provider Details

I. General information

NPI: 1124254545
Provider Name (Legal Business Name): SOUTH CENTRAL COLFAX COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31039B HWY 64
CIMARRON NM
87714-9646
US

IV. Provider business mailing address

31039B HWY 64
CIMARRON NM
87714-9646
US

V. Phone/Fax

Practice location:
  • Phone: 575-377-3301
  • Fax: 575-376-2107
Mailing address:
  • Phone: 575-377-3301
  • Fax: 575-376-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNABELLE SILLAS-GRAVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-377-3301