DE BACA FAMILY PRACTICE CLINIC


Address: 552 Us Hwy 54, Santa Rosa, NM 88435
Phone: 5754722414

DE BACA FAMILY PRACTICE CLINIC (NPI# 1962743534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1962743534
Entity Type Organization
Organization Name DE BACA FAMILY PRACTICE CLINIC
Other Organization Name GUADALUPE FAMILY DENTAL
Practice Address 552 Us Hwy 54
Santa Rosa
NM 88435
Mailing Address Po Box 349
Fort Sumner
NM 88119-0349
Practice Telephone 5754722414
Practice Fax Number 5754722416
Mailing Telephone 5753552414
Mailing Fax Number 5753557894
Enumeration Date 2013-03-07
Last Update Date 2018-02-01
Authorized Official Name LISA WALRAVEN (CEO)
Authorized Official Telephone 5753552420
Is Organization Subpart Y
Parent Organization Name DE BACA FAMILY PRACTICE CLINIC

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 261QD0000X Clinic/Center
Specialization: Dental
NM Ambulatory Health Care Facilities
Y 261QF0400X Clinic/Center
Specialization: Federally Qualified Health Center (FQHC)
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
NM 84331534 05

Other Provider/Organization Names

Other Name Type Code
Guadalupe Family Dental Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1699082644 De Baca Family Practice Clinic Clinic/Center 1001 Sumner Ave, Fort Sumner, NM 88119-0349 2010-09-10
1003855032 De Baca Family Practice Clinic Clinic/Center 546 N. Tenth St, Fort Sumner, NM 88119 2006-06-05

Office Location

Street Address 552 US HWY 54
City SANTA ROSA
State NM
Zip Code 88435

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1326548322 Katherine E Cerico Physical Therapist 1972 Historic Route 66, Santa Rosa, NM 88435 2018-02-15
1770017055 Michael Montoya Social Worker 724 Park Lake Drive, Santa Rosa, NM 88435 2017-04-13
1447592498 Mark Land Grossetete Psychiatry & Neurology 117 Camino De Vida Ste 300, Santa Rosa, NM 88435 2013-03-17
1861728032 Sonya Mireles Counselor 501 S Fourth St, Santa Rosa, NM 88435 2009-10-23
1255664231 Victoria N Silva Counselor 501 S. Forth St., Santa Rosa, NM 88435 2009-09-09
1922039171 Santa Rosa Medical Clinic Internal Medicine 533 Lake Dr, Santa Rosa, NM 88435 2006-07-06
1467750653 Cassidy Ruth Huffman Counselor 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435 2011-03-11
1134455306 Anita Valencia Counselor 501 S Fourth St, Santa Rosa, NM 88435 2009-10-23
1841273554 Dawn R Back Physician Assistant 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435 2005-11-28
1952621070 Erica Nicole Romero Social Worker 260 N 3rd St, Santa Rosa, NM 88435-2006 2010-06-11
Find all providers in zip 88435

Taxonomy Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1386960862 Su Clinica Familiar Clinic/Center Hwy 107 and La Feria Avenue, Santa Rosa, TX 78593-0226 2010-04-09
1871651273 Santa Rosa Community Health Centers Clinic/Center 599 Bellevue Ave, Santa Rosa, CA 95407-7713 2006-12-05
1245739697 Santa Rosa Community Health Center Clinic/Center 3883 Airway Dr Ste 202, Santa Rosa, CA 95403-1671 2018-02-12
1780195255 Santa Rosa Community Health Centers Clinic/Center 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 2017-10-23
1518345511 Santa Rosa Community Health Centers Clinic/Center 3333 Chanate Rd, Santa Rosa, CA 95404-1707 2015-05-11
1184909103 Santa Rosa Community Health Centers Clinic/Center 983 Sonoma Ave, Santa Rosa, CA 95404-4818 2011-10-21
1558512624 Santa Rosa Community Health Centers Clinic/Center 711 Stony Point Rd Ste 17, Santa Rosa, CA 95407-6848 2008-10-07
1114120623 Santa Rosa Community Health Centers Clinic/Center 751 Lombardi Court, Santa Rosa, CA 95407-6793 2007-06-11
1578766085 Santa Rosa Community Health Centers Clinic/Center 751 Lombardi Ct Ste B, Santa Rosa, CA 95407-6793 2007-06-11
1487857991 Santa Rosa Community Health Centers Clinic/Center 751 Lombardi Court, Santa Rosa, CA 95407-6793 2007-06-11
Find all providers in SANTA ROSA

Competitor

Search similar providers

City SANTA ROSA
Zip Code 88435

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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