| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 09/22/2015 |
| Medicare PECOS PAC ID | 5193636041 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1730150178 PECOS PAC ID: 8224295738 Enrollment ID: I20120209000832 |
| Provider Name | Caitlin Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437653060 PECOS PAC ID: 5092051094 Enrollment ID: I20190111002613 |
Pecos Valley Medical Center-school Based Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 28 Panther Parkway, 63 North Highway, Pecos, NM 87552 Phone: 505-757-7053 | |
Pecos Valley Medical Center, Inc Teen School Based Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: North Highway 63, Panther Parkway, Pecos, NM 87552 Phone: 505-757-6482 Fax: 505-757-2700 | |
Pecos Valley Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 199 Highway 50 Bldg A, Pecos, NM 87552 Phone: 505-757-6482 Fax: 505-443-8304 |