Healthcare Provider Details

I. General information

NPI: 1225161474
Provider Name (Legal Business Name): ROSWELL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EAST 2ND STREET
DEXTER NM
88230
US

IV. Provider business mailing address

116 EAST 2ND STREET
DEXTER NM
88230
US

V. Phone/Fax

Practice location:
  • Phone: 505-734-5817
  • Fax: 505-734-6550
Mailing address:
  • Phone: 505-734-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number6687
License Number StateNM

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953