Healthcare Provider Details

I. General information

NPI: 1780031617
Provider Name (Legal Business Name): PRESBYTERIAN MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WILSHIRE AVE NE STE C
ALBUQUERQUE NM
87113-2569
US

IV. Provider business mailing address

PO BOX 2267
SANTA FE NM
87504-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-4090
  • Fax:
Mailing address:
  • Phone: 505-982-5565
  • Fax: 505-992-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG SMITH
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 505-982-5565