Provider Demographics
NPI:1053407460
Name:PRESBYTERIAN MEDICAL SERVICES
Entity type:Organization
Organization Name:PRESBYTERIAN MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:505-327-4796
Mailing Address - Street 1:1895 HOLLYHOCK CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4701
Mailing Address - Country:US
Mailing Address - Phone:505-327-1009
Mailing Address - Fax:
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-327-4796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR55878261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherNURSE PRACTITIONER