NPIMap

Organization Active NPI

Roswell Hospital

  • Psychiatry Physician
  • Roswell, NM
National Provider Identifier
1619902863
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2002-0076 Issued in NM
Legal business name
ROSWELL HOSPITAL
Practice address
405 W Country Club Rd
Roswell, NM 88201-5209
Phone
(505) 622-8170
Fax
(505) 624-8751
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael Portacci
Title
Group VP
Phone
(615) 465-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 2002-0076 NM Primary

Addresses

Primary practice location

405 W Country Club Rd
Roswell, NM 88201-5209

Mailing address

405 W Country Club Rd
Roswell, NM 88201-5209
Phone (505) 622-8170

Other names 1

  • Eastern New Mexico Medical Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eastern New Mexico Medi6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619902863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 W COUNTRY CLUB RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015209",
            "telephone_number": "505-622-8170",
            "fax_number": "505-624-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W COUNTRY CLUB RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015209",
            "telephone_number": "505-622-8170",
            "fax_number": "505-624-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSWELL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PORTACCI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "GROUP VP",
        "authorized_official_telephone_number": "615-465-7000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "2002-0076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern New Mexico Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.