Healthcare Provider Details

I. General information

NPI: 1871630665
Provider Name (Legal Business Name): MINERS COLFAX MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 6TH ST
RATON NM
87740-4224
US

IV. Provider business mailing address

200 HOSPITAL DR
RATON NM
87740-2013
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-4518
  • Fax:
Mailing address:
  • Phone: 505-445-3661
  • Fax: 505-445-4518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5083
License Number StateNM

VIII. Authorized Official

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