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	3336C0002X	Clinic Pharmacy	PH00001660	NM
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3209637	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952474744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 2267
Second Line	:	ATTN CENTRAL OFFICE PHARMACY
City	:	SANTA FE
State	:	NM
Zip	:	87504-2267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W BROADWAY
Second Line	:	STE D
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-327-4796
Fax Number	:	505-599-9351

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	DOUG SMITH
Credential	:
Telephone Number	:	505-982-5565

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	01/16/2026

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Directions to “PRESBYTERIAN MEDICAL SERVICES ” Practice Location

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