Provider Demographics
NPI:1740331370
Name:TAOS MUNICIPAL SCHOOLS SCHOOL BASED HEALTH CENTERS
Entity type:Organization
Organization Name:TAOS MUNICIPAL SCHOOLS SCHOOL BASED HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES, SBHC COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAVEZ, MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-751-8032
Mailing Address - Street 1:213 PASEO DEL CANON E
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6239
Mailing Address - Country:US
Mailing Address - Phone:505-751-8032
Mailing Address - Fax:505-751-8008
Practice Address - Street 1:134 CERVANTES ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6163
Practice Address - Country:US
Practice Address - Phone:505-751-8032
Practice Address - Fax:505-751-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCL00010194363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ1853Medicaid