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2355 Avendia De Mesilla Mesilla NM 88046 | |
(575) 526-1105 | |
(575) 524-4266 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2355 Avendia De Mesilla, Mesilla, New Mexico |
Authorized Official Name and Position | Virgil Medina (CEO) |
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 | 2355 Avendia De Mesilla Mesilla NM 88046 Ph: (575) 526-1105 |
NPI Number | 1528443967 |
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Provider Enumeration Date | 07/28/2015 |
Last Update Date | 05/13/2021 |
Medicare PECOS PAC ID | 6305745191 |
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Medicare Enrollment ID | O20160728000199 |
Identifier | Type | State | Issuer |
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1528443967 | NPI | - | NPPES |
321945 | Other | NM | MEDICARE |
52334520 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |