De Baca Family Practice Clinic

LBN: De Baca Family Practice Clinic
De Baca Family Practice Clinic is an health care organization with primary practice located at 546 N. Tenth St , Fort Sumner NM 88119. The organization recently has only one registered license in Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), which is considered as the primary health care specialty. De Baca Family Practice Clinic can be contacted via phone (505) 355-2414, or through Walraven, Lisa via phone (575) 355-2414.

Contact Information

Primary practice address
546 N. Tenth St Fort Sumner NM 88119
Phone: (505) 355-2414
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Walraven, Lisa
Phone: (575) 355-2414

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1003855032
LBN Legal business name De Baca Family Practice Clinic
DBA Doing business as
Authorized official Walraven, Lisa
Entity Organization
Organization subpart 1 No
Enumeration date Jun 5th, 2006
Last updated Feb 19th, 2019 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003855032 NPPES
New Mexico Other 321863 NGS ID

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