Healthcare Provider Details

I. General information

NPI: 1194751958
Provider Name (Legal Business Name): TAOS HEALTH SYSTEMS INC HOLY CROSS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-6284
US

IV. Provider business mailing address

1397 WEIMER RD
TAOS NM
87571-6284
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-8883
  • Fax:
Mailing address:
  • Phone: 575-758-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5432
License Number StateNM

VIII. Authorized Official

Name: MR. RIC EISENRING
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 575-758-8883