1639310436 NPI number — TAOS HEALTH SYSTEMS INC HOLY CROSS

Table of content: (NPI 1639310436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639310436 NPI number — TAOS HEALTH SYSTEMS INC HOLY CROSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAOS HEALTH SYSTEMS INC HOLY CROSS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROFESSIONAL BILLING SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639310436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1398 WEIMER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87571-6397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-758-8549
Provider Business Mailing Address Fax Number:
575-751-3723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1398 WEIMER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87571-6397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-758-8549
Provider Business Practice Location Address Fax Number:
575-751-3723
Provider Enumeration Date:
03/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GUEVARA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
PFS DIRECTOR
Authorized Official Telephone Number:
575-751-5705

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00760 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2255321 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 45716 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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