Provider Demographics
NPI:1255324562
Name:HIDALGO MEDICAL SERVICES
Entity Type:Organization
Organization Name:HIDALGO MEDICAL SERVICES
Other - Org Name:HMS SILVER HIGH SCHOOL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-542-2322
Mailing Address - Street 1:530 DE MOSS ST
Mailing Address - Street 2:
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:575-542-2388
Practice Address - Street 1:3200 SILVER STREET
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7283
Practice Address - Country:US
Practice Address - Phone:575-534-1015
Practice Address - Fax:575-542-2388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIDALGO MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-23
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03537261QF0400X
261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11602384Medicaid
NM11602384Medicaid
321894Medicare Oscar/Certification
32 1894Medicare UPIN