| La Clinica Del Pueblo De Rio Arriba | |
|
Us Hwy 84, County Road 0324, #14 Tierra Amarilla NM 87575-0250 | |
| (575) 588-7252 | |
| (575) 588-9132 |
| Full Name | La Clinica Del Pueblo De Rio Arriba |
|---|---|
| Speciality | Clinic/Center |
| Location | Us Hwy 84, County Road 0324, #14, Tierra Amarilla, New Mexico |
| Authorized Official Name and Position | Paula G Gurule (INTERIM EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5755887252 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Clinica Del Pueblo De Rio Arriba Po Box 250 Us Hwy 84, County Road 0324, #14 Tierra Amarilla NM 87575-0250 Ph: (575) 588-7252 | La Clinica Del Pueblo De Rio Arriba Us Hwy 84, County Road 0324, #14 Tierra Amarilla NM 87575-0250 Ph: (575) 588-7252 |
| NPI Number | 1598797805 |
|---|---|
| Provider Enumeration Date | 07/07/2006 |
| Last Update Date | 12/08/2023 |
| Medicare PECOS PAC ID | 9638148018 |
|---|---|
| Medicare Enrollment ID | O20041001000529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598797805 | NPI | - | NPPES |
| 000050740 | Medicaid | NM | |
| 1366581373 | Other | NM | JODI K. CASADOS |
| 1467742015 | Other | NM | LUIGI A. DULANTO, M.D. |
| 00050740 | Medicaid | NM | |
| 1215129291 | Other | NM | AMBULANCE |
| 1730472085 | Other | NM | LEVI I. MAES, M.D. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Tamara A Singleton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881779304 PECOS PAC ID: 6305926288 Enrollment ID: I20080104000215 |
| Provider Name | Jodi K Casados |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366581373 PECOS PAC ID: 6901989342 Enrollment ID: I20080208000249 |
| Provider Name | Levi I Maes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730472085 PECOS PAC ID: 6406090174 Enrollment ID: I20150916000351 |
Escalante School Base Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: U S Hwy 84, County Road 0324, #14, Tierra Amarilla, NM 87575 Phone: 575-588-7252 Fax: 575-588-9132 |