Organization
PRESBYTERIAN MEDICAL SERVICES
Active
Other names
OJO ENCINO NAVAJO CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG SMITH (EXECUTIVE VICE PRESIDENT)
(505) 992-5565
Entity
Organization
Contact information
Practice address
2 OJO ENCINO CHAPTER RD, OJO ENCINO, NM 87013
(505) 731-2268
(505) 731-2379
Mailing address
PO BOX 2267, SANTA FE, NM 87504-2267
(505) 982-5565
(505) 992-4990
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
1023186707
NM
332900000X
Non-Pharmacy Dispensing Site
CL00007174
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3209548
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
321824
FQHC CLINIC/CENTER
NM
05
—
48421
—
NM
Enumeration date
12/01/2006
Last updated
01/09/2021
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