De Baca Family Practice Clinic in Fort Sumner - Federally Qualified Health Center (fqhc)
De Baca Family Practice Clinic - NPI 1003855032
De Baca Family Practice Clinic is a Federally Qualified Health Center (fqhc) in Fort Sumner, New Mexico. De Baca Family Practice Clinic practices all healthcare services and medical treatments related to Federally Qualified Health Center (fqhc). The NPI Number for De Baca Family Practice Clinic is 1003855032. The last update date is 2019-02-19.
De Baca Family Practice Clinic's current location address is 546 N. Tenth St, Fort Sumner, New Mexico. You can contact this provider via phone number 5053552414. The mailing address for De Baca Family Practice Clinic is 546 N. Tenth St, Fort Sumner, New Mexico. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | De Baca Family Practice Clinic |
|---|---|
| Address | 546 N. Tenth St, Fort Sumner, New Mexico |
| Phone Number | 5053552414 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | CEO |
|---|---|
| Authorized Official Name | Walraven Lisa |
| Telephone Number | 5753552414 |
NPI Number Detail
| NPI Number | 1003855032 |
|---|---|
| Provider Enumeration Date | 2006-06-05 |
| Last Updated Date | 2019-02-19 |
Provider Mailing Address Detail
| Address | 546 N. Tenth St |
|---|---|
| City | Fort Sumner |
| State | New Mexico (NM) |
| Post Code | 88119 |
| Phone Number | 5053552414 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Federally Qualified Health Center (fqhc) |
|---|---|
| Taxonomy | 261Qf0400X |
|
Definition: Provides primary and preventive care services in underserved areas, receiving certain federal funding grants. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 321863 | NM | NGS ID |
Post Comment/ Review Below
What is the unique identifier code issued to De Baca Family Practice Clinic by the Centers for Medicare & Medicaid Services (CMS)?
The De Baca Family Practice Clinic has been assigned the NPI (National Provider Identifier) 1003855032. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you please share the complete physical address where De Baca Family Practice Clinic is geographically located?
The De Baca Family Practice Clinic is physically situated at the following location: 546 N. Tenth St, Fort Sumner, NM, 88119.
What is the area of specialization for De Baca Family Practice Clinic, and what is the corresponding taxonomy classification code for this field?
The specialized field of practice for De Baca Family Practice Clinic is Federally Qualified Health Center (fqhc), and the corresponding taxonomy code that categorizes this area of expertise is 261Qf0400X.
On what date did the De Baca Family Practice Clinic receive its 1003855032 assignment from the Centers for Medicare & Medicaid Services?
The De Baca Family Practice Clinic was assigned its 1003855032 by the Centers for Medicare & Medicaid Services on 2006-06-05.
When was the information regarding De Baca Family Practice Clinic most recently updated?
The details pertaining to the De Baca Family Practice Clinic, including its address, specialty, and other relevant information, were last refreshed on 2019-02-19.
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