Provider Demographics
NPI:1891070777
Name:TAOS PROFESSIONAL SERVICES,LLC
Entity Type:Organization
Organization Name:TAOS PROFESSIONAL SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNGR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-751-5746
Mailing Address - Street 1:1397 WEIMER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6253
Mailing Address - Country:US
Mailing Address - Phone:575-758-8883
Mailing Address - Fax:575-751-7661
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-751-5746
Practice Address - Fax:575-751-7661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAOS HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-11
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty