Healthcare Provider Details

I. General information

NPI: 1053397497
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W 21ST ST
CLOVIS NM
88101-2011
US

IV. Provider business mailing address

PO BOX 26666 PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-469-7577
  • Fax: 505-769-7595
Mailing address:
  • Phone: 505-823-8528
  • Fax: 505-823-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number59304
License Number StateNM

VIII. Authorized Official

Name: MR. MARK REIFSTECK
Title or Position: SR VP CHIEF OPERATING OFFICER
Credential:
Phone: 505-841-1392