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General NPI Number Information
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NPI Number | 1093801292
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Entity Type | Organization
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Legal Business Name | ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 42121 US HWY 70
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City | PORTALES
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State | NM
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Zip | 88130-9357
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Country | US
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Telephone | 575-356-6652
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Fax | 505-226-3636
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Provider Business Mailing Address
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Address Line | PO BOX 299 42121 US HWY 70
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City | PORTALES
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State | NM
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Zip | 88130-0299
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Country | US
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Telephone | 575-356-6652
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Fax | 505-226-3636
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Authorized Official
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Title or Position | CEO ADMINISTRATOR
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Name | DR. LARRY LEAMING
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Credential |
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Telephone | 505-359-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 072
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MD2004-0760
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2004-0707
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA2004-0028
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2010-0626
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License Number State | NM
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 87-277
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License Number State | NM
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CNP-01941
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License Number State | NM
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2010-0558
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License Number State | NM
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A-1584-10
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License Number State | NM
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CNP00289
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License Number State | NM
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Taxonomy #11
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2011-0222
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License Number State | NM
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