Provider Demographics
NPI:1386813087
Name:EASTERN NEW MEXICO UNIVERSITY-ROSWELL BRANCH COMMUNITY COLLEGE
Entity type:Organization
Organization Name:EASTERN NEW MEXICO UNIVERSITY-ROSWELL BRANCH COMMUNITY COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHAIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:575-624-7233
Mailing Address - Street 1:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-6000
Mailing Address - Country:US
Mailing Address - Phone:575-624-7233
Mailing Address - Fax:575-624-7100
Practice Address - Street 1:31 GAIL HARRIS ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-8190
Practice Address - Country:US
Practice Address - Phone:575-347-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM010962Medicaid