Provider Demographics
NPI:1215193941
Name:HIDALGO MEDICAL SERVICES
Entity Type:Organization
Organization Name:HIDALGO MEDICAL SERVICES
Other - Org Name:HMS COPPER MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRANDSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-542-2322
Mailing Address - Street 1:530 DEMOSS STREET
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-542-8384
Mailing Address - Fax:575-542-8367
Practice Address - Street 1:3185 N LESLIE RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7211
Practice Address - Country:US
Practice Address - Phone:575-388-3393
Practice Address - Fax:575-388-2696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIDALGO MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-01
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCL00010668207Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
321905Medicare Oscar/Certification
400521008Medicare PIN
32 1905Medicare UPIN