South Central Colfax County Special Hospital District
Organization Active NPI Clinical Medical Laboratory · Springer, NM
NPI 1588890909 · NPPES record last updated Dec 9, 2024
Key facts
- NPI
- 1588890909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- Legal business name
- SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
- Practice address
- 615 Prospect Ave
Springer, NM 87747 - Phone
- (575) 483-3300
- Fax
- (575) 483-3344
- NPI assigned
- Jun 1, 2009
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTH CENTRAL COLFAX COUNTY SPECIAL HOSPITAL DISTRICT
Authorized official
- Name
- Ashley Deherrera
- Title
- Administrator
- Phone
- (575) 483-3301
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 4
-
Valerie A Burgelin, CFNP
-
Lisa A Wentling, PA-C
-
Michael J Rossi, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D0536885 | Colfax General Laboratory | Compliance | Oct 10, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110418000121 | NM | Part B Supplier - Independent Clinical Laboratory | 6800070707 | Practice locations: Springer, NM |
National Provider Directory
- Tax ID family
- South Central Colfax County Special Hospital District
- Part of
- South Central Colfax County Special Hospital District
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
615 Prospect Ave
Springer, NM 87747
Mailing address
615 Prospect Ave
Springer, NM 87747
Phone (575) 483-3300
Other names
- COLFAX GENERAL LABORATORY
Other providers in Springer, NM
- Presbyterian Healthcare Services
- Rebecca Ramirez
- Anthony Ramos
- Estevan Antonio Romero
- South Central Colfax County Special Hospital District
- Jessica Tafoya
- Tony Pesavento
- Town of Springer
- Rosalynn M Tyree
- Amy Urquijo
All providers in Springer, NM · Clinical Medical Laboratory in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.