1780878074 NPI number — HIDALGO MEDICAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780878074 NPI number — HIDALGO MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIDALGO MEDICAL 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:
HMS SILVER CITY MENTAL HEALTH CENTER
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:
1780878074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 DEMOSS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LORDSBURG
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88045-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-542-2368
Provider Business Mailing Address Fax Number:
575-542-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-542-2368
Provider Business Practice Location Address Fax Number:
575-542-2388
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
FORREST
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
575-542-2368

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3255 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 3255 , 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: 41805755 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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