| El Centro Family Health Coyote Clinic | |
|
State Road 96 House #3396 Coyote NM 87012-0040 | |
| (575) 638-5487 | |
| (575) 638-9123 |
| Full Name | El Centro Family Health Coyote Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | State Road 96, Coyote, New Mexico |
| Authorized Official Name and Position | Lore Pease (CEO) |
| Authorized Official Contact | 5057537218 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| El Centro Family Health Coyote Clinic 538 N Paseo De Onate P.o. Box 158 Espanola NM 87532-2618 Ph: (505) 753-7218 | El Centro Family Health Coyote Clinic State Road 96 House #3396 Coyote NM 87012-0040 Ph: (575) 638-5487 |
| NPI Number | 1619132362 |
|---|---|
| Provider Enumeration Date | 07/22/2008 |
| Last Update Date | 11/21/2014 |
| Medicare PECOS PAC ID | 9830080688 |
|---|---|
| Medicare Enrollment ID | O20090113000883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619132362 | NPI | - | NPPES |
| 47142 | Medicaid | NM | |
| 1780389034 | Other | NM | ORGANIZATION NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6000 (New Mexico) | Primary |