Provider Demographics
NPI:1194751958
Name:TAOS HEALTH SYSTEMS INC HOLY CROSS HOSPITAL
Entity type:Organization
Organization Name:TAOS HEALTH SYSTEMS INC HOLY CROSS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-758-8883
Mailing Address - Street 1:1397 WEIMER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6284
Mailing Address - Country:US
Mailing Address - Phone:575-758-8883
Mailing Address - Fax:
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6284
Practice Address - Country:US
Practice Address - Phone:575-758-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM163W00000X, 207L00000X, 207P00000X, 207R00000X, 208M00000X, 282N00000X
NM5432282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45716Medicaid
NM00760Medicaid
NM2255321OtherMIEDICARE PTAN
NM320013Medicare Oscar/Certification
NM2255321Medicare Oscar/Certification