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56 Panther Boulevard Animas NM 88020 | |
(575) 548-2742 | |
(575) 542-2388 |
Full Name | |
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Speciality | Clinic/Center |
Location | 56 Panther Boulevard, Animas, New Mexico |
Authorized Official Name and Position | Daniel Otero (CEO) |
Authorized Official Contact | 5755428384 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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530 De Moss St Lordsburg NM 88045-2618 Ph: (575) 542-2368 | 56 Panther Boulevard Animas NM 88020 Ph: (575) 548-2742 |
NPI Number | 1548253701 |
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Provider Enumeration Date | 08/23/2005 |
Last Update Date | 03/12/2020 |
Medicare PECOS PAC ID | 4587572250 |
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Medicare Enrollment ID | O20090812000578 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548253701 | NPI | - | NPPES |
E1329 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |