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General NPI Number Information
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NPI Number | 1982521001
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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 | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 2200 W 21ST ST
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City | CLOVIS
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State | NM
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Zip | 88101-2011
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Country | US
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Telephone | 575-769-7577
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Fax | 575-769-7596
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Provider Business Mailing Address
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Address Line | PO BOX 26666
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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 | MANAGER PROVIDER ENROLMENT
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Name | KIMBERLY T POLAND
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Credential |
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Telephone | 505-923-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family 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 | 208000000X
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Taxonomy Name | Pediatrics 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 | 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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