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1 Salomon Griego Road Veguita NM 87062 | |
(505) 443-7701 | |
(505) 864-8646 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1 Salomon Griego Road, Veguita, 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 |
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Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 820-3466 | 1 Salomon Griego Road Veguita NM 87062 Ph: (505) 443-7701 |
NPI Number | 1487119608 |
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Provider Enumeration Date | 02/01/2019 |
Last Update Date | 04/07/2022 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20190522000644 |
Identifier | Type | State | Issuer |
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1487119608 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |