MEDICARE: PRESBYTERIAN MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	I-06083	NM

General Provider Information

NPI Number	:	1083861355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	851 ANDREA DR
Second Line	:	SUITE 4, BUILDING E
City	:	FARMINGTON
State	:	NM
Zip	:	87401-6726
Country	:	US
Telephone Number	:	505-324-5855
Fax Number	:	505-324-5896

Provider Business Practice Location Address
First Line	:	851 ANDREA DR
Second Line	:	SUITE 4, BUILDING E
City	:	FARMINGTON
State	:	NM
Zip	:	87401-6726
Country	:	US
Telephone Number	:	505-324-5855
Fax Number	:	505-324-5896

Authorized Official
Title or Position	:	CLINICAL SERVICES ADMINISTRATOR
Name	:	MRS. MELISA R MORTENSEN
Credential	:	LISW
Telephone Number	:	505-324-5855

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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Directions to “PRESBYTERIAN MEDICAL SERVICES ” Practice Location

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