| Fcmbh-pc | |
|
1003 Luna Cir Nw Albuquerque NM 87102-1973 | |
| (505) 504-5505 | |
| (505) 214-5614 |
| Full Name | Fcmbh-pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1003 Luna Cir Nw, Albuquerque, New Mexico |
| Authorized Official Name and Position | Shannon Solis Baca (OFFICE MANAGER) |
| Authorized Official Contact | 5052009855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fcmbh-pc Po Box 95602 Albuquerque NM 87199 Ph: (505) 504-5505 | Fcmbh-pc 1003 Luna Cir Nw Albuquerque NM 87102-1973 Ph: (505) 504-5505 |
| NPI Number | 1891056909 |
|---|---|
| Provider Enumeration Date | 06/05/2012 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Medicare PECOS PAC ID | 6507092996 |
|---|---|
| Medicare Enrollment ID | O20131113000190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891056909 | NPI | - | NPPES |
| 37776825 | Medicaid | NM |
| Provider Name | Randolph Phillip Baca |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790982643 PECOS PAC ID: 9931335320 Enrollment ID: I20131114000150 |
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