Healthcare Provider Details

I. General information

NPI: 1932445350
Provider Name (Legal Business Name): PRESBYTERIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION NE PRESBYTERIAN MEDICAL GROUP
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

8300 CONSTITUTION NE PRESBYTERIAN MEDICAL GROUP
ALBUQUERQUE NM
87110-7613
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2402
  • Fax:
Mailing address:
  • Phone: 505-291-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberR56893
License Number StateNM

VIII. Authorized Official

Name: NANCY MICHELLE ELLIOTT
Title or Position: COUMADIN CLINIC CARE MANAGER
Credential: RN, BSN
Phone: 505-291-2402