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Presbyterian Medical Services

Organization Active NPI Federally Qualified Health Center (FQHC) · Socorro, NM

NPI 1407898034 · NPPES record last updated Jan 9, 2021

Key facts

NPI
1407898034
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Practice address
1300 Enterprise
Socorro, NM 87801
Phone
(505) 835-4444
Fax
(505) 835-1010
NPI assigned
Jun 11, 2006
Organization subpart
No

Authorized official

Name
Doug Smith
Title
Executive Vice President
Phone
(505) 982-5565

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D1027906PMS Socorro Community Health Center
1300 Enterprise Road, Socorro, NM 87801		Certificate of waiverJul 15, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Federally qualified health center certification: CCN 321896

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
SOCORRO COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 1, 2004
Last certification
Sep 1, 2004
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
1300 Enterprise Rd
Socorro, NM 87801-4199

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anne Liley
Individual 		Corporate Director
Board Member		 Feb 11, 2016
Mario Atencio
Individual 		Corporate Director
Board Member		 Mar 12, 2019
Anthony Armijo
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Robert Mitchell
Individual 		Corporate Director May 1, 2009
Steven C Hansen
Individual 		Corporate Officer
President		 Nov 1, 2007
Corporate Director
President		 Nov 1, 2007
Scott Michlin
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Doug Smith
Individual 		Corporate Officer
Executive Vice President & Treas		 Aug 22, 2011
Laura Jaramillo
Individual 		Corporate Director
Board Member		 Nov 1, 2021
Marlene Waukazoo
Individual 		Corporate Director
Board Member		 Nov 1, 2012
Don Daniel
Individual 		Corporate Officer
Corporate Secretary		 May 2, 2014
Diane Lopez
Individual 		Corporate Officer
Vice President & Corporate Secre		 Aug 22, 2011
Patricia Collins
Individual 		Corporate Director
Board Member		 May 2, 2014
Bryan Romkey
Individual 		Corporate Director
Board Member		 Feb 5, 2015
Hilda Keller
Individual 		Corporate Director
Board Member		 Jul 1, 2021
Lillie Lewis
Individual 		Corporate Director
Board Member		 May 2, 2013
Frank McCasland
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Melissa Sharpe
Individual 		Corporate Director
Board Member		 Feb 5, 2015
Daniel Evans
Individual 		Corporate Director
Board Member		 Feb 1, 2017
Susan K Smith
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Cynthia Rael-Vigil
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Kent E Mosbrucker
Individual 		W-2 Managing Employee
Vice President of Finance		 Aug 31, 2018

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Santa Fe Family Health Center
Sante Fe, NM · CCN 321950		 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20101014000687 NM Part a Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Socorro, NM

National Provider Directory

Tax ID family
PMS Questa Health Cente (70 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NM Yes
Non-Pharmacy Dispensing Site 332900000X
Pharmacy 333600000X CL00010337 NM

Addresses

Primary practice location

1300 Enterprise
Socorro, NM 87801

Mailing address

PO Box 2267
Presbyterian Medical SVCS Inc
Santa Fe, NM 87504

Other identifiers

IdentifierTypeStateIssuer
3211137OtherOTHER ID NUMBER-COMMERCIAL NUMBER
31637809MedicaidNM

Other names

  • Socorro Community Health Cntr Doing business as

Other providers in Socorro, NM

All providers in Socorro, NM · Federally Qualified Health Center (FQHC) in New Mexico

Sources for this page

Verify at the official NPI Registry.