Organization
PICURIS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA TAYLOR CHACON (CLINICAL PRACTICE MANAGER)
(505) 927-0918
Entity
Organization
Contact information
Practice address
201 K-2 BUFFALO TRAIL ROAD, PENASCO, NM 87553
(575) 999-5796
Mailing address
PO BOX 127, 201 K 2 BUFFALO TRAIL RD, PENASCO, NM 87553-0127
(505) 927-0918
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
124Q00000X
Dental Hygienist
—
—
152W00000X
Optometrist
—
—
156FX1800X
Optician
—
—
163W00000X
Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
225X00000X
Occupational Therapist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/21/2025
Last updated
11/17/2025
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