Samantha Palos
Individual provider Active NPI Physician Assistant · Hatch, NM
NPI 1154619922 · NPPES record last updated Jan 31, 2024
Key facts
- NPI
- 1154619922
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA2023-0300 (NM)
- Practice address
- 255 Highway 187
Hatch, NM 87937-7001 - Phone
- (575) 267-3088
- Fax
- (575) 267-4565
- NPI assigned
- Jul 14, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240215002445 | NM | Practitioner - Physician Assistant | 6204270416 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-4917 | NM | MD | Speech-Language Pathologist |
| PA2023-0300 | NM | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ben Archer Health Center | Current |
Accepting new patients | |
| Ben Archer Health Center | Current |
Accepting new patients | |
| Ben Archer Health Center | Past | Accepting new patients |
Locations
1960 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-7662
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | C-4917 | NM | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA2023-0300 | NM | Yes |
Addresses
Primary practice location
255 Highway 187
Hatch, NM 87937-7001
Mailing address
832A Mountain Laurel Cir SE
Albuquerque, NM 87116-1249
Phone (575) 635-3833
Other providers in Hatch, NM
- Richard Mathias
- Clyde Kennedy Miller
- Raquel Neeley
- Alejandra Ochoa
- Anna Karen Olvera
- Reyna K Ramirez
- Lorenzo Ramos Jr.
- Anna Salazar
- Guadalupe Salazar
- Guilus Schultz
All providers in Hatch, NM · Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.