Presbyterian Medical Services
Organization Active NPI Federally Qualified Health Center (FQHC) · Magdalena, NM
NPI 1972682425 · NPPES record last updated Apr 3, 2008
Key facts
- NPI
- 1972682425
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 6768 (NM)
- Legal business name
- PRESBYTERIAN MEDICAL SERVICES
- Practice address
- 801 10TH St
Magdalena, NM 87825 - Phone
- (505) 854-3161
- Fax
- (505) 854-3160
- NPI assigned
- Nov 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Roberta Lee
- Title
- Cfo
- Phone
- (505) 982-5565
Corporate family (same tax ID) 13
Related certifications (CCN) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Federally qualified health center certification: CCN 321875
- Legal name
- PRESBYTERIAN MEDICAL SERVICES
- Doing business as
- MAGDALENA AREA HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 15, 2000
- Last certification
- Mar 15, 2000
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 1, 1969 in NM
- Enrollment address
- 801 Tenth St
Magdalena, NM 87825 - Related CCNs
- 321861
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Anne Liley |
Corporate Director |
Feb 11, 2018 | |
| Mario Atencio |
Corporate Director |
Mar 12, 2019 | |
| Anthony Armijo |
Corporate Director |
Aug 22, 2011 | |
| Keith Riddle |
Corporate Director |
Aug 22, 2011 | |
| Steven C Hansen |
Corporate Officer |
Nov 1, 2007 | |
| Michelle Maes |
Corporate Director |
Feb 11, 2016 | |
| Scott Michlin |
Corporate Director |
Aug 22, 2011 | |
| Doug Smith |
Corporate Officer |
Aug 22, 2011 | |
| Marlene Waukazoo |
Corporate Director |
Nov 1, 2012 | |
| Don Daniel |
Corporate Officer |
May 2, 2014 | |
| Diane Lopez |
Corporate Officer |
Aug 22, 2011 | |
| Patricia Collins |
Corporate Director |
May 2, 2014 | |
| Bryan Romkey |
Corporate Director |
Feb 5, 2015 | |
| Lillie Lewis |
Corporate Director |
May 2, 2013 | |
| Frank McCasland |
Corporate Director |
Aug 22, 2011 | |
| Melissa Sharpe |
Corporate Director |
Feb 5, 2015 | |
| Daniel Evans |
Corporate Director |
Feb 1, 2017 | |
| Susan K Smith |
Corporate Director |
Aug 22, 2011 | |
| Cynthia Rael-Vigil |
Corporate Director |
Aug 22, 2011 | |
| Kent E Mosbrucker |
W-2 Managing Employee |
Aug 31, 2018 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Santa Fe Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Oct 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100811000853 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 2062324684 | Practice locations: Magdalena, NM |
National Provider Directory
- Tax ID family
- PMS Questa Health Cente
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 6768 | NM | Yes |
| Non-Pharmacy Dispensing Site | 332900000X | CL00007618 | NM |
Addresses
Primary practice location
801 10TH St
Magdalena, NM 87825
Mailing address
PO Box 2267
Santa Fe, NM 87504-2267
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3210426 | Other | OTHER ID NUMBER | |
| Z5896 | Medicaid | NM |
Other names
- MAGDALENA AREA HEALTH CENTER
Other providers in Magdalena, NM
- Magdalena Cabin Counseling
- Brittany N Martinez
- New World Transportation Non Emergency LLC
- Staci Elizabeth Oldham
- Aimee Pawlcyn
- Lyndia A Radice
- Holly Reynolds Hagy
- Village of Magdalena
- Carrie L Willey
All providers in Magdalena, NM · Federally Qualified Health Center (FQHC) 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 Apr 3, 2008. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.