Provider Demographics
NPI:1578802518
Name:HIDALGO MEDICAL SERVICES
Entity Type:Organization
Organization Name:HIDALGO MEDICAL SERVICES
Other - Org Name:ENA MITCHELL SENIOR AND WELLNESS CENTER
Other - Org Type:Other Name
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:575-542-2307
Mailing Address - Fax:575-542-2388
Practice Address - Street 1:532 DEMOSS ST.
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:575-542-2353
Practice Address - Fax:575-542-2388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIDALGO MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-12
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3429261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1 T 3429OtherOPERATORS LICENSE
NM3429OtherNM DOH OPERATORS LICENSE