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General NPI Number Information
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NPI Number | 1235966789
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN MEDICAL SERVICES
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 204 W 2ND ST STE 1
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City | ROSWELL
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State | NM
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Zip | 88201-4669
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Country | US
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Telephone | 575-840-4088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2267
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City | SANTA FE
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State | NM
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Zip | 87504-2267
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Country | US
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Telephone | 505-982-5565
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Fax | 505-992-4990
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | DOUG SMITH
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Credential |
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Telephone | 505-982-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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