Provider Demographics
NPI:1538286521
Name:EGIS-ELDERS GETTING INFORMATION AND SERVICES
Entity Type:Organization
Organization Name:EGIS-ELDERS GETTING INFORMATION AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH, CMC, MS
Authorized Official - Phone:505-995-0485
Mailing Address - Street 1:PO BOX 8132
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-8132
Mailing Address - Country:US
Mailing Address - Phone:505-995-0485
Mailing Address - Fax:505-986-8581
Practice Address - Street 1:227 E PALACE AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2043
Practice Address - Country:US
Practice Address - Phone:505-995-0485
Practice Address - Fax:505-986-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD3633Medicaid