MEDICARE: HIDALGO MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center	200740	NM
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073506911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIDALGO MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	530 DE MOSS ST
Second Line	:
City	:	LORDSBURG
State	:	NM
Zip	:	88045-2618
Country	:	US
Telephone Number	:	575-542-2368
Fax Number	:	575-542-2388

Provider Business Practice Location Address
First Line	:	1107 TOM FOY BLVD
Second Line	:
City	:	BAYARD
State	:	NM
Zip	:	88023-9793
Country	:	US
Telephone Number	:	575-534-5069
Fax Number	:	575-542-2388

Authorized Official
Title or Position	:	CEO
Name	:	DANIEL OTERO
Credential	:
Telephone Number	:	575-542-2322

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	03/04/2016

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Directions to “HIDALGO MEDICAL SERVICES ” Practice Location

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