Healthcare Provider Details

I. General information

NPI: 1851861587
Provider Name (Legal Business Name): CLAYTON HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 FRANCIS AVENUE
DES MOINES NM
88418
US

IV. Provider business mailing address

300 WILSON ST
CLAYTON NM
88415-3304
US

V. Phone/Fax

Practice location:
  • Phone: 575-278-2619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE CHAVEZ
Title or Position: CEO
Credential:
Phone: 575-347-2585