MEDICARE: PRESBYTERIAN 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	261QF0400X	Federally Qualified Health Center (FQHC)		NM

General Provider Information

NPI Number	:	1477975688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 2267
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87504-2267
Country	:	US
Telephone Number	:	505-982-5565
Fax Number	:	505-992-4990

Provider Business Practice Location Address
First Line	:	2300 GRANDE BLVD SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1636
Country	:	US
Telephone Number	:	505-896-0928
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	DOUG SMITH
Credential	:
Telephone Number	:	505-820-3447

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	01/09/2021

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Directions to “PRESBYTERIAN MEDICAL SERVICES ” Practice Location

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