Healthcare Provider Details

I. General information

NPI: 1588685457
Provider Name (Legal Business Name): NEW MEXICO PSYCHIATRIC SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N UNION AVE
ROSWELL NM
88201-3267
US

IV. Provider business mailing address

PO BOX 8244
ROSWELL NM
88202-8244
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-0224
  • Fax: 575-616-5626
Mailing address:
  • Phone: 505-624-2121
  • Fax: 505-624-7981

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: BABAK MIRIN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 505-624-2121