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General NPI Number Information
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NPI Number | 1831266311
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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 | 11/29/2006
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 15 E NAVARRE
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City | THOREAU
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State | NM
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Zip | 87323
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Country | US
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Telephone | 505-862-7417
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Fax | 505-443-8346
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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 |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VP
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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 | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | CL00007400
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | NM
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