| El Centro Family Health Penasco Clinic | |
|
State Road 75 #15136 Penasco NM 87553-2627 | |
| (575) 587-2205 | |
| (575) 587-1944 |
| Full Name | El Centro Family Health Penasco Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | State Road 75 #15136, Penasco, 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 Penasco Clinic 538 N Paseo De Onate P.o. Box 158 Espanola NM 87532-2618 Ph: (505) 753-7218 | El Centro Family Health Penasco Clinic State Road 75 #15136 Penasco NM 87553-2627 Ph: (575) 587-2205 |
| NPI Number | 1790940716 |
|---|---|
| Provider Enumeration Date | 07/21/2008 |
| Last Update Date | 05/04/2015 |
| Medicare PECOS PAC ID | 9830080688 |
|---|---|
| Medicare Enrollment ID | O20090113000834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790940716 | NPI | - | NPPES |
| 1780689034 | Other | NM | ORGANIZATION NPPES |
| 47092 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6102 (New Mexico) | Primary |
Holy Cross Hospital Penasco Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: #24 Highway 73, Penasco, NM 87553 Phone: 575-587-1833 Fax: 575-587-1918 | |
El Centro Family Health Psbhc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14190 State Road 75, Penasco, NM 87553 Phone: 575-587-2623 Fax: 575-587-2317 |