Pecos Valley Medical Center, Inc
Organization Active NPI Community Health Clinic/Center · Pecos, NM
NPI 1497801047 · NPPES record last updated Sep 22, 2015
Key facts
- NPI
- 1497801047
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- License
- 6263 (NM)
- Legal business name
- PECOS VALLEY MEDICAL CENTER, INC
- Practice address
- 199 Hwy 50
Pecos, NM 87552-0710 - Phone
- (505) 757-6482
- Fax
- (505) 757-2700
- NPI assigned
- Jan 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Kevin Norris
- Title
- Cfo
- Phone
- (505) 757-6482
Subparts reporting this organization as parent 1
Practitioners 2
-
Caitlin Thomas, CNP
-
Lucien David Young, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120113000192 | NM | Part B Supplier - Clinic/Group Practice | 5193636041 |
Receives reassigned benefits from 2 practitioners Practice locations: Pecos, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 6263 | NM | Yes |
| Clinic Pharmacy | 3336C0002X | CL00007120 | NM |
Addresses
Primary practice location
199 Hwy 50
Pecos, NM 87552-0710
Mailing address
PO Box 710
Pecos, NM 87552-0710
Phone (505) 757-6482
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046623 | Medicaid | NM |
Other providers in Pecos, NM
- Nathan Pack
- Pecos Independent School District
- Pecos Valley Ambulance Service
- Pecos Valley Ambulance Service
- Pecos Valley Medical Center, Inc
- Richard C Peters
- Pilar Healthcare LLC
- Presbyterian Medical Services
- Presbyterian Medical Services
- Claudia Quan
All providers in Pecos, NM · Community Health Clinic/Center 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 Sep 22, 2015. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.