NPIMap

Organization Active NPI

South Central Colfax County Special Hospital District

Doing business as Moreno Valley Urgent Care @ Angel Fire Resort

  • Urgent Care Clinic/Center
  • Angel Fire, NM
National Provider Identifier
1487470977
Registry record updated Nov 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Doing business as
Moreno Valley Urgent Care @ Angel Fire Resort
Practice address
10 Five Springs Rd.
Angel Fire, NM 87710
Phone
(575) 377-3301
NPI assigned
Nov 29, 2024
Last updated
Nov 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ashley Deherrera
Title
Administrator
Phone
(575) 483-3301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

10 Five Springs Rd.
Angel Fire, NM 87710

Mailing address

PO Box 133
Angel Fire, NM 87710-0133
Phone (575) 377-3301

Other names 1

  • Moreno Valley Urgent Care @ Angel Fire Resort Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2325278Moreno Valley Urgent Care at Angel Fire Resort10 Five Springs Rd, Angel Fire, NM 87710Certificate of waiverJun 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
South Central Colfax County3 organizations share this tax ID, including this one
Part of
South Central Colfax County

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1487470977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 133",
            "city": "ANGEL FIRE",
            "state": "NM",
            "postal_code": "877100133",
            "telephone_number": "575-377-3301",
            "fax_number": "575-377-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FIVE SPRINGS RD.",
            "city": "ANGEL FIRE",
            "state": "NM",
            "postal_code": "87710",
            "telephone_number": "575-377-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT",
        "enumeration_date": "2024-11-29",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "DEHERRERA",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "575-483-3301"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moreno Valley Urgent Care @ Angel Fire Resort",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Angel Fire, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.