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General NPI Number Information
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NPI Number | 1336124205
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN HEALTHCARE SERVICES
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1202 HIGHWAY 60 WEST
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City | SOCORRO
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State | NM
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Zip | 87801-3914
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Country | US
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Telephone | 505-835-1140
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Fax | 505-835-8716
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-5356
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Fax | 505-923-5354
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Authorized Official
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Title or Position | REGULATORY COMPLIANCE
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Name | VICTORIA M CARMIGNANI
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Credential |
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Telephone | 505-923-5356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 3014
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License Number State | NM
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