Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 8 Old Town Loop, Quemado, New Mexico |
Authorized Official Name and Position | Doug Smith (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 5059825565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | 8 Old Town Loop Quemado NM 87829 Ph: (575) 773-4610 |
NPI Number | 1760540553 |
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Provider Enumeration Date | 12/05/2006 |
Last Update Date | 04/07/2022 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20091214000248 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760540553 | NPI | - | NPPES |
70281 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 32D0887987 (New Mexico) | Primary |