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546 N 10th Street Fort Sumner NM 88119 | |
| (575) 355-2414 | |
| (575) 355-7894 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 546 N 10th Street, Fort Sumner, New Mexico |
| Authorized Official Name and Position | Lisa Walraven (CEO) |
| Authorized Official Contact | 5753552420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 349 Fort Sumner NM 88119-0349 Ph: (575) 355-2414 | 546 N 10th Street Fort Sumner NM 88119 Ph: (575) 355-2414 |
| NPI Number | 1114737483 |
|---|---|
| Provider Enumeration Date | 01/09/2025 |
| Last Update Date | 01/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114737483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
De Baca Family Practice Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 546 N. Tenth St, Fort Sumner, NM 88119 Phone: 505-355-2414 | |