| El Centro Family Health Penasco Dental Clinic | |
|
15136 St. Rd. Penasco NM 87553-0000 | |
| (575) 587-2809 | |
| (575) 587-2605 |
| Full Name | El Centro Family Health Penasco Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 15136 St. Rd., Penasco, New Mexico |
| Authorized Official Name and Position | Lore Pease (CEO) |
| Authorized Official Contact | 5057537218 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| El Centro Family Health Penasco Dental Clinic 538 N Paseo De Onate P.o. Box 158 Espanola NM 87532-2618 Ph: (505) 752-7218 | El Centro Family Health Penasco Dental Clinic 15136 St. Rd. Penasco NM 87553-0000 Ph: (575) 587-2809 |
| NPI Number | 1164782462 |
|---|---|
| Provider Enumeration Date | 05/21/2012 |
| Last Update Date | 06/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164782462 | NPI | - | NPPES |
| 1780689034 | Other | NM | ORGANIZATION NPPES |
| 47092 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |