Provider Demographics
NPI:1285863738
Name:HIDALGO MEDICAL SERVICES
Entity Type:Organization
Organization Name:HIDALGO MEDICAL SERVICES
Other - Org Name:HMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HMS CEO
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:N
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-542-8384
Mailing Address - Street 1:530 DEMOSS STREET
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:575-542-8367
Practice Address - Street 1:530 DEMOSS STREET
Practice Address - Street 2:
Practice Address - City:LORDSBURG
Practice Address - State:NM
Practice Address - Zip Code:88045-2618
Practice Address - Country:US
Practice Address - Phone:575-542-8384
Practice Address - Fax:575-542-8367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIDALGO MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-06
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6500111N00000X, 207Q00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty