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18420 S Highway 28 La Mesa NM 88044-9605 | |
(575) 233-3830 | |
(575) 233-4542 |
Full Name | |
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Speciality | Clinic/Center |
Location | 18420 S Highway 28, La Mesa, New Mexico |
Authorized Official Name and Position | Virgil Medina (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5755261105 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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385 Calle De Alegra Bldg. A Las Cruces NM 88005-3423 Ph: (575) 526-1105 | 18420 S Highway 28 La Mesa NM 88044-9605 Ph: (575) 233-3830 |
NPI Number | 1396718631 |
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Provider Enumeration Date | 02/08/2006 |
Last Update Date | 05/13/2021 |
Medicare PECOS PAC ID | 6305745191 |
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Medicare Enrollment ID | O20100803001137 |
Identifier | Type | State | Issuer |
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1396718631 | NPI | - | NPPES |
48215 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New Mexico) | Primary |