Organization
THOREAU CLINIC
Active
Parent organization
DHHS PHS NAIHS CROWNPOINT HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHHS PHS NAIHS CROWNPOINT HOSPITAL
Authorized official
MR. ANSLEM ROANHORSE (CEO)
(505) 786-5291
Entity
Organization
Contact information
Practice address
3 NAVARRE STREET, THOREAU, NM 87323
(505) 862-8250
(505) 862-8909
Mailing address
PO BOX 358, CROWNPOINT, NM 87313-0358
(505) 786-5291
(505) 786-6440
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HSZ145
MEDICARE GROUP PTAN
NM
05
—
R2903
—
NM
Enumeration date
06/14/2006
Last updated
10/18/2012
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