Provider Demographics
NPI:1780878074
Name:HIDALGO MEDICAL SERVICES
Entity type:Organization
Organization Name:HIDALGO MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:N
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-542-2368
Mailing Address - Street 1:530 DEMOSS STREET
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-542-2368
Mailing Address - Fax:575-542-2388
Practice Address - Street 1:301 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5002
Practice Address - Country:US
Practice Address - Phone:575-542-2368
Practice Address - Fax:575-542-2388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIDALGO MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-30
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3255101YM0800X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41805755Medicaid
400521008Medicare PIN
321903Medicare Oscar/Certification
32 1903Medicare UPIN