MEDICARE: HIDALGO 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1972843779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIDALGO MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	530 DEMOSS ST.
Second Line	:
City	:	LORDSBURG
State	:	NM
Zip	:	88045-2618
Country	:	US
Telephone Number	:	575-542-2368
Fax Number	:	575-542-2388

Provider Business Practice Location Address
First Line	:	1318 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7252
Country	:	US
Telephone Number	:	575-388-1511
Fax Number	:	575-542-2388

Authorized Official
Title or Position	:	CEO
Name	:	HARRIET P BRANDSTETTER
Credential	:
Telephone Number	:	575-542-2368

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	01/09/2014

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Directions to “HIDALGO MEDICAL SERVICES ” Practice Location

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