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501 W 4th St Lordsburg NM 88045-1643 | |
(575) 542-3389 | |
(575) 542-2388 |
Full Name | |
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Speciality | Clinic/Center |
Location | 501 W 4th St, Lordsburg, New Mexico |
Authorized Official Name and Position | Daniel Otero (CEO) |
Authorized Official Contact | 5755422322 |
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 | 501 W 4th St Lordsburg NM 88045-1643 Ph: (575) 542-3389 |
NPI Number | 1689881245 |
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Provider Enumeration Date | 05/16/2007 |
Last Update Date | 03/04/2016 |
Medicare PECOS PAC ID | 4587572250 |
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Medicare Enrollment ID | O20070511000602 |
Identifier | Type | State | Issuer |
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1689881245 | NPI | - | NPPES |
78001064 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QS1000X | Clinic/center - Student Health | 7678 (New Mexico) | Secondary |