1598740482 NPI number — PRESBYTERIAN HEALTHCARE SERVICES

Table of content: (NPI 1598740482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598740482 NPI number — PRESBYTERIAN HEALTHCARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN HEALTHCARE SERVICES
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:
PRESBYTERIAN KASEMAN PSYCH UNIT
Provider Other Organization Name Type Code:
3
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:
1598740482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/24/2015
NPI Reactivation Date:
07/30/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26666
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87125-6666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-923-5356
Provider Business Mailing Address Fax Number:
505-923-5354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 CONSTITUTION AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-7613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-291-5300
Provider Business Practice Location Address Fax Number:
505-291-5301
Provider Enumeration Date:
12/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAXWELL
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE/CFO DELIVERY SYSTEM
Authorized Official Telephone Number:
505-923-5353

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273R00000X , with the licence number: 6114 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 225720 0 . This is a "MEDICARE PART B" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 00993 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".