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2 Ojo Encino Chapter Rd Ojo Encino NM 87013 | |
(505) 731-2268 | |
(505) 731-2379 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2 Ojo Encino Chapter Rd, Ojo Encino, New Mexico |
Authorized Official Name and Position | Doug Smith (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 5059925565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | 2 Ojo Encino Chapter Rd Ojo Encino NM 87013 Ph: (505) 731-2268 |
NPI Number | 1023186707 |
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Provider Enumeration Date | 12/01/2006 |
Last Update Date | 01/09/2021 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20091110000585 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023186707 | NPI | - | NPPES |
3209548 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
321824 | Other | NM | FQHC CLINIC/CENTER |
48421 | Medicaid | NM |