Western Nm Medical Group Thoreau | |
15 Navarre Thoreau NM 87323 | |
(505) 862-7417 | |
(505) 862-8300 |
Full Name | Western Nm Medical Group Thoreau |
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Speciality | Clinic/Center |
Location | 15 Navarre, Thoreau, New Mexico |
Authorized Official Name and Position | Roberta Lee (CFO) |
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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Western Nm Medical Group Thoreau Po Box 2267 Santa Fe NM 87504-2267 Ph: () - | Western Nm Medical Group Thoreau 15 Navarre Thoreau NM 87323 Ph: (505) 862-7417 |
NPI Number | 1831266311 |
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Provider Enumeration Date | 11/29/2006 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20101014001071 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831266311 | NPI | - | NPPES |
3209699 | Other | OTHER ID NUMBER | |
50162 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New Mexico) | Primary |
332900000X | Non-pharmacy Dispensing Site | CL00007400 (New Mexico) | Secondary |
Thoreau Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3 Navarre Street, Thoreau, NM 87323 Phone: 505-862-8250 Fax: 505-862-8909 |