Healthcare Provider Details

I. General information

NPI: 1871505032
Provider Name (Legal Business Name): PRESBYTERIAN MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD
RIO RANCHO NM
87124-1058
US

IV. Provider business mailing address

PO BOX 2267
SANTA FE NM
87504-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax: 505-896-0585
Mailing address:
  • Phone: 505-982-5565
  • Fax: 505-992-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number6613
License Number StateNM

VIII. Authorized Official

Name: MRS. ROBERTA LEE
Title or Position: CFO
Credential:
Phone: 505-982-5565