Provider Demographics
NPI:1215163639
Name:SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-483-3301
Mailing Address - Street 1:11 ELLIOTT
Mailing Address - Street 2:
Mailing Address - City:ANGEL FIRE
Mailing Address - State:NM
Mailing Address - Zip Code:87710
Mailing Address - Country:US
Mailing Address - Phone:575-377-3301
Mailing Address - Fax:575-377-3991
Practice Address - Street 1:11 ELLIOTT BARKER ROAD
Practice Address - Street 2:
Practice Address - City:ANGEL FIRE
Practice Address - State:NM
Practice Address - Zip Code:87710
Practice Address - Country:US
Practice Address - Phone:575-377-3301
Practice Address - Fax:575-377-3991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service