Healthcare Provider Details

I. General information

NPI: 1285863738
Provider Name (Legal Business Name): HIDALGO MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 DEMOSS STREET
LORDSBURG NM
88045-2618
US

IV. Provider business mailing address

530 DEMOSS STREET
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-542-8384
  • Fax: 575-542-8367
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6500
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number6500
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6500
License Number StateNM

VIII. Authorized Official

Name: FORREST N OLSON
Title or Position: HMS CEO
Credential:
Phone: 575-542-8384