Healthcare Provider Details

I. General information

NPI: 1902143977
Provider Name (Legal Business Name): MINERS COLFAX MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOSPITAL DR
RATON NM
87740-2012
US

IV. Provider business mailing address

203 HOSPITAL DR
RATON NM
87740-2012
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-3661
  • Fax: 575-445-7737
Mailing address:
  • Phone: 575-445-3661
  • Fax: 575-445-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6143
License Number StateNM

VIII. Authorized Official

Name: BRIAN ROLAND
Title or Position: CEO
Credential:
Phone: 575-445-7722