Organization
PRESBYTERIAN MEDICAL SERVICES
Active
Other names
ORTIZ MOUNTAIN HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTA LEE (CFO)
(505) 982-5565
Entity
Organization
Contact information
Practice address
06B MAIN ST, CERRILLOS, NM 87010
(505) 470-6266
(505) 471-5861
Mailing address
PO BOX 2267, SANTA FE, NM 87504-2267
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
6515
NM
332900000X
Non-Pharmacy Dispensing Site
CL00007440
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3209803
OTHER ID NUMBER
—
05
—
F4919
—
NM
Enumeration date
11/29/2006
Last updated
11/02/2011
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