| El Centro Family Health Evhs Sbhc | |
|
1111 El Llano Rd Espanola NM 87532-6727 | |
| (505) 753-7357 | |
| (905) 747-8659 |
| Full Name | El Centro Family Health Evhs Sbhc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1111 El Llano Rd, Espanola, 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 Evhs Sbhc 538 N Paseo De Onate P.o. Box 158 Espanola NM 87532-2618 Ph: (505) 753-7218 | El Centro Family Health Evhs Sbhc 1111 El Llano Rd Espanola NM 87532-6727 Ph: (505) 753-7357 |
| NPI Number | 1437575289 |
|---|---|
| Provider Enumeration Date | 03/17/2014 |
| Last Update Date | 11/21/2014 |
| Medicare PECOS PAC ID | 9830080688 |
|---|---|
| Medicare Enrollment ID | O20141105001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437575289 | NPI | - | NPPES |
| 99250721 | Medicaid | NM | |
| 1780689034 | Other | NM | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4491 (New Mexico) | Primary |
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