| El Centro Family Health Wagon Mound Clinic | |
|
604 Catron Avenue Wagon Mound NM 87752-0063 | |
| (575) 666-2288 | |
| (575) 666-2186 |
| Full Name | El Centro Family Health Wagon Mound Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 604 Catron Avenue, Wagon Mound, New Mexico |
| Authorized Official Name and Position | Lore C. 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 Wagon Mound Clinic 538 N Paseo De Onate P.o. Box 158 Espanola NM 87532-2618 Ph: (505) 753-7218 | El Centro Family Health Wagon Mound Clinic 604 Catron Avenue Wagon Mound NM 87752-0063 Ph: (575) 666-2288 |
| NPI Number | 1538324223 |
|---|---|
| Provider Enumeration Date | 07/23/2008 |
| Last Update Date | 11/21/2014 |
| Medicare PECOS PAC ID | 9830080688 |
|---|---|
| Medicare Enrollment ID | O20090113000796 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538324223 | NPI | - | NPPES |
| 1780689034 | Other | NM | ORGANIZATION NPPES |
| 47670 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 47670 (New Mexico) | Primary |
Sunrise Clinics - Wagon Mound Sbhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 Parker Ave, Wagon Mound, NM 87752 Phone: 575-472-4311 Fax: 877-651-0289 |