| De Baca Family Practice Clinic | |
|
1001 Sumner Ave Fort Sumner NM 88119-0349 | |
| (575) 355-4431 | |
| (575) 355-4432 |
| Full Name | De Baca Family Practice Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1001 Sumner Ave, Fort Sumner, New Mexico |
| Authorized Official Name and Position | Lisa Walraven (CEO) |
| Authorized Official Contact | 5753552420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| De Baca Family Practice Clinic Po Box 349 Fort Sumner NM 88119-0349 Ph: (575) 355-2414 | De Baca Family Practice Clinic 1001 Sumner Ave Fort Sumner NM 88119-0349 Ph: (575) 355-4431 |
| NPI Number | 1699082644 |
|---|---|
| Provider Enumeration Date | 09/10/2010 |
| Last Update Date | 01/22/2025 |
| Medicare PECOS PAC ID | 6406758358 |
|---|---|
| Medicare Enrollment ID | O20180212002394 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699082644 | NPI | - | NPPES |
| 38003384 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 3069 (New Mexico) | Primary |
De Baca Family Practice Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 546 N. Tenth St, Fort Sumner, NM 88119 Phone: 505-355-2414 | |
De Baca Family Practice Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 546 N 10th Street, Fort Sumner, NM 88119 Phone: 575-355-2414 Fax: 575-355-7894 | |
Desert Hope Wellness Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1176 Salt Cedar Dr, Fort Sumner, NM 88119 Phone: 701-203-3373 |