Healthcare Provider Details

I. General information

NPI: 1093801292
Provider Name (Legal Business Name): ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42121 US HWY 70
PORTALES NM
88130-9357
US

IV. Provider business mailing address

PO BOX 299 42121 US HWY 70
PORTALES NM
88130-0299
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-6652
  • Fax: 505-226-3636
Mailing address:
  • Phone: 575-356-6652
  • Fax: 505-226-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number072
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2011-0222
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA2004-0028
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0626
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87-277
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP-01941
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0558
License Number StateNM
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-1584-10
License Number StateNM
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP00289
License Number StateNM
# 11
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2004-0707
License Number StateNM
# 12
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD2004-0760
License Number StateNM

VIII. Authorized Official

Name: DR. LARRY LEAMING
Title or Position: CEO ADMINISTRATOR
Credential:
Phone: 505-359-1800