Basic Information
| Provider Information | |||||||||
| NPI: | 1902338049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAOS HEALTH SYSTEMS, INC., HOLY CROSS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1397 WEIMER RD | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757588883 | ||||||||
| FaxNumber: | 5757515719 | ||||||||
| Practice Location | |||||||||
| Address1: | 1397 WEIMER RD | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757588883 | ||||||||
| FaxNumber: | 5757515719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | ROZENBOOM | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5757515713 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 6432 | NM | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 760 | 05 | NM | MEDICAID |