Pecos Valley Medical Center, Inc | |
199 Hwy 50 Pecos NM 87552-0710 | |
(505) 757-6482 | |
(505) 757-2700 |
Full Name | Pecos Valley Medical Center, Inc |
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Speciality | Clinic/Center |
Location | 199 Hwy 50, Pecos, New Mexico |
Authorized Official Name and Position | Kevin Norris (CFO) |
Authorized Official Contact | 5057576482 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pecos Valley Medical Center, Inc Po Box 710 Pecos NM 87552-0710 Ph: (505) 757-6482 | Pecos Valley Medical Center, Inc 199 Hwy 50 Pecos NM 87552-0710 Ph: (505) 757-6482 |
NPI Number | 1497801047 |
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Provider Enumeration Date | 01/26/2007 |
Last Update Date | 09/22/2015 |
Medicare PECOS PAC ID | 5193636041 |
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Medicare Enrollment ID | O20120113000192 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497801047 | NPI | - | NPPES |
046623 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | 6263 (New Mexico) | Primary |
3336C0002X | Pharmacy - Clinic Pharmacy | CL00007120 (New Mexico) | Secondary |
Provider Name | Lucien D Young |
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Provider Type | Practitioner - Osteopathic Manipulative Medicine |
Provider Identifiers | NPI Number: 1730150178 PECOS PAC ID: 8224295738 Enrollment ID: I20120209000832 |
Provider Name | Caitlin Thomas |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437653060 PECOS PAC ID: 5092051094 Enrollment ID: I20190111002613 |