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General NPI Number Information
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NPI Number | 1558347708
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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 | 12/20/2005
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 211 SUDDERTH DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6002
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Country | US
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Telephone | 505-257-7381
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Fax | 505-630-4233
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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 | VP REGIONAL OPERATIONS
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Name | MR. BO BEAMES
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Credential |
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Telephone | 505-923-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 3199
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 3199
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License Number State | NM
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