Organization
STATE OF NEW MEXICO
Active
Parent organization
NM DEPARTMENT OF HEALTH
Other names
Fort Bayard Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
NM DEPARTMENT OF HEALTH
Authorized official
SHERRI BAYS (CFO)
(575) 537-8606
Entity
Organization
Contact information
Practice address
41 FORT BAYARD ROAD, SANTA CLARA, NM 88026
(575) 537-8600
(575) 537-8869
Mailing address
PO BOX 293, SANTA CLARA, NM 88026-0293
(575) 537-8600
(575) 537-3753
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
5011
NM
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
5011
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014
MOLINA HEALTHCARE
NM
01
—
3204574
N.A.B.P. IDENTIFIER #
NM
05
—
50716
—
NM
05
—
51972786
—
NM
01
—
AL3362097
D.E. A. IDENTIFIER NUMBER
NM
01
—
NM00N526
BLUE CROSS BLUE SHIELD
NM
Enumeration date
02/26/2007
Last updated
12/12/2024
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