Basic Information
| Provider Information | |||||||||
| NPI: | 1497462592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PMS PRESBYTERIAN MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2360 INDIAN WELLS RD | ||||||||
| Address2: | |||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883104609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754377404 | ||||||||
| FaxNumber: | 5754392860 | ||||||||
| Practice Location | |||||||||
| Address1: | 2360 INDIAN WELLS RD | ||||||||
| Address2: | |||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883104609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754377404 | ||||||||
| FaxNumber: | 5754392860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FUENTES | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | COMMUNITY SUPPORT WORKER - CHILDREN | ||||||||
| AuthorizedOfficialTelephone: | 5754377404 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CSW | ||||||||
| NPICertificationDate: | 10/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.