Healthcare Provider Details

I. General information

NPI: 1245216688
Provider Name (Legal Business Name): PRESBYTERIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 CONSTITUTION PL NE SUITE 120
ALBUQUERQUE NM
87110-7643
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-1122
  • Fax: 505-559-6067
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number6529A1INPATIENT
License Number StateNM

VIII. Authorized Official

Name: MR. DALE MAXWELL
Title or Position: VP FINANCE/CFO DELIVERY SYSTEM
Credential:
Phone: 505-923-5353