| Lcdf Desert Pride School Base | |
|
100 Shrode Rd Anthony NM 88021-7350 | |
| (575) 526-1105 | |
| (575) 524-4266 |
| Full Name | Lcdf Desert Pride School Base |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Shrode Rd, Anthony, New Mexico |
| Authorized Official Name and Position | Virgil Medina (CEO) |
| Authorized Official Contact | 5755261105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lcdf Desert Pride School Base 385 Calle De Alegra Ste A Las Cruces NM 88005-3423 Ph: (575) 526-1105 | Lcdf Desert Pride School Base 100 Shrode Rd Anthony NM 88021-7350 Ph: (575) 526-1105 |
| NPI Number | 1114578671 |
|---|---|
| Provider Enumeration Date | 09/26/2019 |
| Last Update Date | 05/13/2021 |
| Medicare PECOS PAC ID | 6305745191 |
|---|---|
| Medicare Enrollment ID | O20191031000714 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114578671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Gadsden High School-based Health Center (adolescent Services) Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Highway 28, Gadsden High School-based Health Center, Anthony, NM 88021 Phone: 575-882-6300 Fax: 575-882-2370 | |
Anthony Behavioral Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 826 Anthony Dr., Anthony, NM 88021 Phone: 575-201-5136 Fax: 575-524-4266 | |
Gadsden School Base Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6301 Nm Highway 28, Anthony, NM 88021 Phone: 575-525-4817 Fax: 575-525-4818 |