| El Centro Family Health Psbhc | |
|
14190 State Road 75 Penasco NM 87553 | |
| (575) 587-2623 | |
| (575) 587-2317 |
| Full Name | El Centro Family Health Psbhc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14190 State Road 75, 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 Psbhc 538 N Paseo De Onate P.o. Box 158 Espanola NM 87532-2618 Ph: (505) 753-7218 | El Centro Family Health Psbhc 14190 State Road 75 Penasco NM 87553 Ph: (575) 587-2623 |
| NPI Number | 1912324724 |
|---|---|
| Provider Enumeration Date | 03/19/2014 |
| Last Update Date | 11/21/2014 |
| Medicare PECOS PAC ID | 9830080688 |
|---|---|
| Medicare Enrollment ID | O20140918000810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912324724 | NPI | - | NPPES |
| 1780689034 | Other | NM | NPPES |
| 03025365 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | 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 Penasco Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: State Road 75 #15136, Penasco, NM 87553 Phone: 575-587-2205 Fax: 575-587-1944 |