Provider Demographics
NPI:1235597964
Name:TAOS PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:TAOS PROFESSIONAL SERVICES, LLC
Other - Org Name:TAOS HEALTH SYSTEMS PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-751-5714
Mailing Address - Street 1:1397 WEIMER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6253
Mailing Address - Country:US
Mailing Address - Phone:575-751-8900
Mailing Address - Fax:575-751-3723
Practice Address - Street 1:1329 GUSDORF RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6282
Practice Address - Country:US
Practice Address - Phone:575-737-3415
Practice Address - Fax:575-737-3416
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAOS PROFESSIONAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4075208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM262945Medicare PIN