Healthcare Provider Details

I. General information

NPI: 1912356619
Provider Name (Legal Business Name): PRESBYTERIAN MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SAKELARES BLVD
GRANTS NM
87020-3819
US

IV. Provider business mailing address

PO BOX 2267
SANTA FE NM
87504-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-876-1890
  • Fax: 505-876-1886
Mailing address:
  • Phone: 505-982-5565
  • Fax: 505-992-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KENT MOSBRUCKER
Title or Position: VP OF FINANCE
Credential:
Phone: 505-982-5565