NPIMap

Organization Active NPI

Lutheran Hospital Association of the San Luis Valley

Doing business as San Luis Valley Health Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Alamosa, CO
National Provider Identifier
1609003250
Registry record updated Jul 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Doing business as
San Luis Valley Health Swing Bed
Practice address
106 Blanca Ave
Alamosa, CO 81101-2340
Phone
(719) 589-2511
Fax
(719) 587-1372
NPI assigned
Jun 22, 2009
Last updated
Jul 1, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2013

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

Authorized official

Name
Mrs. Konnie Martin
Title
Ceo
Phone
(719) 587-1206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

106 Blanca Ave
Alamosa, CO 81101-2340

Mailing address

106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-2511

Other names 1

  • San Luis Valley Health Swing Bed Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100125000820 CO Part A Provider - Hospital 4789589094 Practice locations: Alamosa, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609003250. Details of each certification follow.

Hospital certification: CCN 06U008

Legal name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Doing business as
SLV REGIONAL MEDICAL CENTER
Organization structure
CorporationProprietary
Incorporated
Nov 27, 1937 in CO
Enrollment address
106 Blanca Ave
Alamosa, CO 81101-2340
Other Hospital Practice Location
Hospital subgroups
Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
San Luis Valley Reg Med Ctr11 organizations share this tax ID, including this one
Part of
San Luis Valley Reg Med Ctr

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Karla Hardesty Individual Corporate Director Sep 9, 2009
Shane Mortensen Individual Corporate Officer Jan 1, 2012
W-2 Managing Employee Jan 1, 2012
Konnie Martin Individual Corporate Officer Jul 18, 2013
W-2 Managing Employee Jul 18, 2013

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Luis Valley HealthLa Jara, CO, CCN 061308 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health Conejos County Hospital Swing BedLa Jara, CO, CCN 06Z308 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health Antonito ClinicAntonito, CO, CCN 063992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
SLV Health la Jara ClinicLa Jara, CO, CCN 068513 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2013
Lutheran Hospital Association of the San Luis ValleyMonte Vista, CO, CCN 068523 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 2, 2011

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1609003250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 BLANCA AVE",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012340",
            "telephone_number": "719-589-2511",
            "fax_number": "719-587-1372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BLANCA AVE",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012340",
            "telephone_number": "719-589-2511",
            "fax_number": "719-587-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "enumeration_date": "2009-06-22",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KONNIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-587-1206",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Luis Valley Health Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alamosa, CO

Sources for this page

Verify at the official NPI Registry.