Healthcare Provider Details

I. General information

NPI: 1427041490
Provider Name (Legal Business Name): HIDALGO MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HWY 211
GILA NM
88038-9800
US

IV. Provider business mailing address

530 DE MOSS ST
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-535-4384
  • Fax: 575-542-2388
Mailing address:
  • Phone: 575-542-2368
  • Fax: 575-542-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number3184
License Number StateNM

VIII. Authorized Official

Name: DANIEL OTERO
Title or Position: CEO
Credential:
Phone: 575-542-2322