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826 Anthony Dr. Anthony NM 88021-9346 | |
(575) 201-5136 | |
(575) 524-4266 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 826 Anthony Dr., Anthony, New Mexico |
Authorized Official Name and Position | Vigil Medina (CEO) |
Authorized Official Contact | 5755261105 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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385 Calle De Alegra Bldg A Las Cruces NM 88005-3423 Ph: (575) 526-1105 | 826 Anthony Dr. Anthony NM 88021-9346 Ph: (575) 201-5136 |
NPI Number | 1033599022 |
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Provider Enumeration Date | 06/04/2015 |
Last Update Date | 05/24/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033599022 | NPI | - | NPPES |
2370905 | Other | NM | MEDICARE |
61386561 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |