Healthcare Provider Details

I. General information

NPI: 1811375256
Provider Name (Legal Business Name): HIDALGO MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 E 32ND ST
SILVER CITY NM
88061-7252
US

IV. Provider business mailing address

530 DEMOSS STREET
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-597-2458
  • Fax: 575-542-2388
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number3527
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3527
License Number StateNM

VIII. Authorized Official

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