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805 Tom Foy Blvd Bayard NM 88023-9767 | |
(575) 537-5068 | |
(575) 542-2388 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 805 Tom Foy Blvd, Bayard, New Mexico |
Authorized Official Name and Position | Daniel Otero (CEO) |
Authorized Official Contact | 5755422322 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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530 De Moss St Lordsburg NM 88045-2618 Ph: (575) 542-2368 | 805 Tom Foy Blvd Bayard NM 88023-9767 Ph: (575) 537-5068 |
NPI Number | 1861432015 |
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Provider Enumeration Date | 06/07/2006 |
Last Update Date | 03/04/2016 |
Identifier | Type | State | Issuer |
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1861432015 | NPI | - | NPPES |
98652834 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 3228 (New Mexico) | Primary |