Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 21192 Highway 84, Abiquiu, New Mexico |
Authorized Official Name and Position | Andy R Lopez (CEO) |
Authorized Official Contact | 5755814728 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 237 El Rito NM 87530-0237 Ph: (575) 581-4728 | 21192 Highway 84 Abiquiu NM 87510 Ph: (505) 685-4479 |
NPI Number | 1083834436 |
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Provider Enumeration Date | 04/26/2007 |
Last Update Date | 06/07/2010 |
Medicare PECOS PAC ID | 1456252428 |
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Medicare Enrollment ID | O20090305000694 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083834436 | NPI | - | NPPES |
3209613 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
62988 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |