Healthcare Provider Details

I. General information

NPI: 1154770618
Provider Name (Legal Business Name): ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAIN ST
MELROSE NM
88124-9680
US

IV. Provider business mailing address

PO BOX 233
MELROSE NM
88124-0233
US

V. Phone/Fax

Practice location:
  • Phone: 575-253-4373
  • Fax:
Mailing address:
  • Phone: 575-253-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number3370
License Number StateNM

VIII. Authorized Official

Name: LORENCE LEAMING
Title or Position: CEO
Credential:
Phone: 585-356-3411