De Baca Family Practice Clinic/school Site is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Fort Sumner, New Mexico. The current practice location for De Baca Family Practice Clinic/school Site is 1001 Sumner Ave, Fort Sumner, New Mexico. For appointments, you can reach them via phone at
(575) 355-4431. The mailing address for De Baca Family Practice Clinic/school Site is Po Box 349, Fort Sumner, New Mexico and phone number is (575) 355-2414.
De Baca Family Practice Clinic/school Site is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1699082644. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(575) 355-4431.
Primary Care Clinic Profile
| Full Name | De Baca Family Practice Clinic/school Site |
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| Speciality | Clinic/Center |
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| Location | 1001 Sumner Ave, Fort Sumner, New Mexico |
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| Authorized Official Name and Position | Lisa Walraven (CEO) |
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| Authorized Official Contact | 5753552420 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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De Baca Family Practice Clinic/school Site
Po Box 349
Fort Sumner
NM 88119-0349
Ph: (575) 355-2414 | De Baca Family Practice Clinic/school Site
1001 Sumner Ave
Fort Sumner
NM 88119-0349
Ph: (575) 355-4431 |
NPI Details:
| NPI Number | 1699082644 |
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| Provider Enumeration Date | 09/10/2010 |
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| Last Update Date | 01/31/2018 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 6406758358 |
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| Medicare Enrollment ID | O20180212002394 |
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Medical Identifiers
Medical identifiers for De Baca Family Practice Clinic/school Site such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1699082644 | NPI | - | NPPES |
| 38003384 | Medicaid | NM | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 3069 (New Mexico) | Secondary |
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