Healthcare Provider Details

I. General information

NPI: 1386813087
Provider Name (Legal Business Name): EASTERN NEW MEXICO UNIVERSITY-ROSWELL BRANCH COMMUNITY COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 GAIL HARRIS ST
ROSWELL NM
88203-8190
US

IV. Provider business mailing address

PO BOX 6000
ROSWELL NM
88202-6000
US

V. Phone/Fax

Practice location:
  • Phone: 575-347-3462
  • Fax:
Mailing address:
  • Phone: 575-624-7233
  • Fax: 575-624-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE BATSON
Title or Position: DIVISION CHAIR
Credential: RN
Phone: 575-624-7233