Full Name | |
---|---|
Speciality | Clinic/Center |
Location | #50 County Road 13, Cuba, New Mexico |
Authorized Official Name and Position | Doug Smith (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 5059825565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | #50 County Road 13 Cuba NM 87013 Ph: (575) 289-2082 |
NPI Number | 1740553734 |
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Provider Enumeration Date | 02/22/2012 |
Last Update Date | 04/07/2022 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20120724000429 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740553734 | NPI | - | NPPES |
0000 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
Pueblo Pintado Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: #10 Pueblo Pintado School, Cuba, NM 87013 Phone: 505-655-3501 Fax: 505-862-8909 | |