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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NM | 84331534 | 05 |
Other Name | Type Code |
---|---|
Guadalupe Family Dental | Doing Business As Name - Organization |
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 |
Street Address |
552 US HWY 54 |
City | SANTA ROSA |
State | NM |
Zip Code | 88435 |
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 Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
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 |
City | SANTA ROSA |
Zip Code | 88435 |
Please comment or provide details below to improve the information on DE BACA FAMILY PRACTICE CLINIC.
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.