Healthcare Provider Details

I. General information

NPI: 1710196571
Provider Name (Legal Business Name): DEMING HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W ASH ST
DEMING NM
88030-4000
US

IV. Provider business mailing address

PO BOX 844814
DALLAS TX
75284-4814
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-5800
  • Fax:
Mailing address:
  • Phone: 575-546-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number6552
License Number StateNM

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OP/AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3840