Healthcare Provider Details

I. General information

NPI: 1396661609
Provider Name (Legal Business Name): PRESBYTERIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN EAST FWY NE STE 340
ALBUQUERQUE NM
87109-3574
US

IV. Provider business mailing address

PO BOX 26666 SUITE 355
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8777
  • Fax: 505-823-8829
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY T POLAND
Title or Position: MANAGER PROVIDER ENROLLMENT
Credential:
Phone: 505-923-5355