Provider Demographics
NPI:1144302415
Name:EL PUEBLO HEALTH SERVICES, INC
Entity type:Organization
Organization Name:EL PUEBLO HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CNP
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEFFENS
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-867-2324
Mailing Address - Street 1:121 CALLE DEL PRESIDENTE
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6091
Mailing Address - Country:US
Mailing Address - Phone:505-867-2324
Mailing Address - Fax:505-867-3511
Practice Address - Street 1:121 CALLE DEL PRESIDENTE
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6091
Practice Address - Country:US
Practice Address - Phone:505-867-2324
Practice Address - Fax:505-867-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-263207Q00000X
261QF0400X
NMR34317363LF0000X, 363LF0000X
NMMD2005-0633207R00000X
NMR36350363LF0000X
NMR39438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47902Medicaid
32-1842Medicare Oscar/Certification