Provider Demographics
NPI:1083861355
Name:PRESBYTERIAN MEDICAL SERVICES
Entity Type:Organization
Organization Name:PRESBYTERIAN MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-324-5855
Mailing Address - Street 1:851 ANDREA DR
Mailing Address - Street 2:SUITE 4, BUILDING E
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6726
Mailing Address - Country:US
Mailing Address - Phone:505-324-5855
Mailing Address - Fax:505-324-5896
Practice Address - Street 1:851 ANDREA DR
Practice Address - Street 2:SUITE 4, BUILDING E
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6726
Practice Address - Country:US
Practice Address - Phone:505-324-5855
Practice Address - Fax:505-324-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06083104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty