Healthcare Provider Details

I. General information

NPI: 1578639662
Provider Name (Legal Business Name): ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST STE R1
CLOVIS NM
88101-4098
US

IV. Provider business mailing address

PO BOX 299
PORTALES NM
88130-0299
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-0944
  • Fax: 575-935-0948
Mailing address:
  • Phone: 575-356-6652
  • Fax: 575-359-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM E BOYER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 575-356-3416