Healthcare Provider Details

I. General information

NPI: 1548315864
Provider Name (Legal Business Name): ENMU-ROSWELL SCHOOL BASED HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BLAND ST
ROSWELL NM
88203-7900
US

IV. Provider business mailing address

PO BOX 6000 ATTN JANE BATSON SBHC
ROSWELL NM
88202-6000
US

V. Phone/Fax

Practice location:
  • Phone: 505-627-2808
  • Fax: 505-624-2290
Mailing address:
  • Phone: 505-627-2808
  • Fax: 505-624-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENEVA JEWEL DEARING
Title or Position: HEALTH COORDINATOR
Credential: CMA
Phone: 505-627-2808