NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Loving Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Loving, NM
National Provider Identifier
1891874343
Registry record updated Dec 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6317 Issued in NM
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Loving Health Clinic
Practice address
602 S 4TH St
Loving, NM 88256-0491
Phone
(575) 745-3573
Fax
(575) 745-3550
NPI assigned
Nov 3, 2006
Last updated
Dec 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2011

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

Authorized official

Name
Roberta Lee
Title
Cfo
Phone
(505) 982-5565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6317 NM Primary
Non-Pharmacy Dispensing Site 332900000X CL00007330 NM

Addresses

Primary practice location

602 S 4TH St
Loving, NM 88256-0491

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267

Other identifiers 2

IdentifierTypeStateIssuer
3209651OtherOTHER ID NUMBER
50361MedicaidNM

Other names 1

  • LOVING HEALTH CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111101000217 NM Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Loving, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891874343. Details of each certification follow.

Federally qualified health center certification: CCN 321823

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
LOVING HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
602S 4TH St
Loving, NM 88256

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
32D0915309PMS Loving Health Center602 S 4TH Street, Loving, NM 88256Certificate of waiverJul 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
PMS Dba Roundtree Childrens' Development Services70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

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

View all 23

Ownership & related parties

All disclosed owners & managing parties 18

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
Anthony Armijo Individual Corporate DirectorBoard Member Aug 22, 2011
Robert Mitchell Individual Corporate DirectorBoard Member May 1, 2009
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Scott Michlin Individual Corporate DirectorBoard Member May 1, 2010
Doug Smith Individual Corporate OfficerExecutive VP & Treasurer 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
W-2 Managing EmployeeCorporate Secretary May 2, 2014
Diane Lopez Individual Corporate OfficerVP and Corp Sec 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
Susan K Smith Individual Corporate DirectorBoard Member Aug 22, 2011
Cynthia Rael-Vigil Individual Corporate DirectorBoard Member Aug 22, 2011

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1891874343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2267",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875042267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S 4TH ST",
            "city": "LOVING",
            "state": "NM",
            "postal_code": "882560491",
            "telephone_number": "575-745-3573",
            "fax_number": "575-745-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "505-982-5565"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6317",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NM",
            "license": "CL00007330",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3209651",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50361",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LOVING HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loving, NM

Sources for this page

Verify at the official NPI Registry.