Healthcare Provider Details

I. General information

NPI: 1639310436
Provider Name (Legal Business Name): TAOS HEALTH SYSTEMS INC HOLY CROSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 WEIMER RD
TAOS NM
87571-6397
US

IV. Provider business mailing address

1398 WEIMER RD
TAOS NM
87571-6397
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-8549
  • Fax: 575-751-3723
Mailing address:
  • Phone: 575-758-8549
  • Fax: 575-751-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNM

VIII. Authorized Official

Name: JOSE GUEVARA
Title or Position: PFS DIRECTOR
Credential:
Phone: 575-751-5705