Provider Demographics
NPI:1639310436
Name:TAOS HEALTH SYSTEMS INC HOLY CROSS
Entity Type:Organization
Organization Name:TAOS HEALTH SYSTEMS INC HOLY CROSS
Other - Org Name:PROFESSIONAL BILLING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-751-5705
Mailing Address - Street 1:1398 WEIMER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6397
Mailing Address - Country:US
Mailing Address - Phone:575-758-8549
Mailing Address - Fax:575-751-3723
Practice Address - Street 1:1398 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6397
Practice Address - Country:US
Practice Address - Phone:575-758-8549
Practice Address - Fax:575-751-3723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAOS HEALTH SYSTEMS INC HOLY CROSS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM163W00000X, 207R00000X, 208M00000X, 282N00000X
207L00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00760Medicaid
NM2255321OtherMEDICARE PTAN
NM45716Medicaid
NM00760Medicaid