NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Socorro Community Health Cntr

  • Federally Qualified Health Center (FQHC)
  • Socorro, NM
National Provider Identifier
1407898034
Registry record updated Jan 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Socorro Community Health Cntr
Practice address
1300 Enterprise
Socorro, NM 87801
Phone
(505) 835-4444
Fax
(505) 835-1010
NPI assigned
Jun 11, 2006
Last updated
Jan 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NM Primary
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 names 1

  • Socorro Community Health Cntr Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407898034. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
1300 Enterprise Rd
Socorro, NM 87801-4199

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D1027906PMS Socorro Community Health Center1300 Enterprise Road, Socorro, NM 87801Certificate of waiverJul 15, 2026

National Provider Directory

National Provider Directory
Tax ID family
PMS Questa Health Cente70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

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 DirectorBoard Member Feb 11, 2016
Mario Atencio Individual Corporate DirectorBoard Member Mar 12, 2019
Anthony Armijo Individual Corporate DirectorBoard Member Aug 22, 2011
Robert Mitchell Individual Corporate Director May 1, 2009
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Corporate DirectorPresident Nov 1, 2007
Scott Michlin Individual Corporate DirectorBoard Member Aug 22, 2011
Doug Smith Individual Corporate OfficerExecutive Vice President & Treas Aug 22, 2011
Laura Jaramillo Individual Corporate DirectorBoard Member Nov 1, 2021
Marlene Waukazoo Individual Corporate DirectorBoard Member Nov 1, 2012
Don Daniel Individual Corporate OfficerCorporate Secretary May 2, 2014
Diane Lopez Individual Corporate OfficerVice President & Corporate Secre Aug 22, 2011
Patricia Collins Individual Corporate DirectorBoard Member May 2, 2014
Bryan Romkey Individual Corporate DirectorBoard Member Feb 5, 2015
Hilda Keller Individual Corporate DirectorBoard Member Jul 1, 2021
Lillie Lewis Individual Corporate DirectorBoard Member May 2, 2013
Frank McCasland Individual Corporate DirectorBoard Member Aug 22, 2011
Melissa Sharpe Individual Corporate DirectorBoard Member Feb 5, 2015
Daniel Evans Individual Corporate DirectorBoard Member Feb 1, 2017
Susan K Smith Individual Corporate DirectorBoard Member Aug 22, 2011
Cynthia Rael-Vigil Individual Corporate DirectorBoard Member Aug 22, 2011
Kent E Mosbrucker Individual W-2 Managing EmployeeVice 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 CenterSante Fe, NM, CCN 321950 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1407898034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2267",
            "address_2": "PRESBYTERIAN MEDICAL SVCS INC",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ENTERPRISE",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "87801",
            "telephone_number": "505-835-4444",
            "fax_number": "505-835-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "505-982-5565"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NM",
            "license": "CL00010337",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Socorro Community Health Cntr",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Socorro Community Health Cntr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Socorro, NM

Sources for this page

Verify at the official NPI Registry.