| Mora Valley Community Health Services Inc | |
|
13 Mora Valley Clinic Road State Hwy 518 Mile Marker 26 Mora NM 87732-0209 | |
| (575) 387-5069 | |
| (575) 387-9011 |
| Full Name | Mora Valley Community Health Services Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13 Mora Valley Clinic Road, Mora, New Mexico |
| Authorized Official Name and Position | Wanda Renay Salazar (FINANCE DIRECTOR) |
| Authorized Official Contact | 5753875069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mora Valley Community Health Services Inc Po Box 209 Mora NM 87732 Ph: (575) 387-5069 | Mora Valley Community Health Services Inc 13 Mora Valley Clinic Road State Hwy 518 Mile Marker 26 Mora NM 87732-0209 Ph: (575) 387-5069 |
| NPI Number | 1508840117 |
|---|---|
| Provider Enumeration Date | 12/06/2005 |
| Last Update Date | 01/21/2011 |
| Medicare PECOS PAC ID | 4486541901 |
|---|---|
| Medicare Enrollment ID | O20040301000532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508840117 | NPI | - | NPPES |
| 48504 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 6333 (New Mexico) | Primary |
| Provider Name | James D Lutz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194714741 PECOS PAC ID: 8123001393 Enrollment ID: I20040609000674 |
| Provider Name | John M Tourangeau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750730826 PECOS PAC ID: 4587635032 Enrollment ID: I20040810001019 |
| Provider Name | Amy G Weiss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871500827 PECOS PAC ID: 8224067335 Enrollment ID: I20050809000845 |
| Provider Name | Martin Ruiz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356410104 PECOS PAC ID: 8628070604 Enrollment ID: I20070203000093 |
| Provider Name | Manuel Gonzalez-cuervo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447361951 PECOS PAC ID: 0446381917 Enrollment ID: I20100628000058 |
| Provider Name | James M Mash |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972553238 PECOS PAC ID: 1153583208 Enrollment ID: I20120507000424 |
| Provider Name | Donald W Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083773931 PECOS PAC ID: 4688749336 Enrollment ID: I20150309001574 |
| Provider Name | Francisco H Crespin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679578611 PECOS PAC ID: 1153445234 Enrollment ID: I20150911000878 |
| Provider Name | Dana L Savage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841778073 PECOS PAC ID: 0345594834 Enrollment ID: I20181120001485 |
| Provider Name | Justeen Griego |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437637758 PECOS PAC ID: 9335485986 Enrollment ID: I20190118000405 |
| Provider Name | Pauline Sara Mondragon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740943505 PECOS PAC ID: 5890186472 Enrollment ID: I20211216000545 |
| Provider Name | Clarissa M Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740949049 PECOS PAC ID: 3375936305 Enrollment ID: I20220215000791 |
| Provider Name | Lily Alexandrovna Ryzhkova |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114376381 PECOS PAC ID: 5294075560 Enrollment ID: I20230526001238 |
Mora Valley Community Health Services, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10 Ranger Dr, Mora, NM 87732 Phone: 575-387-3117 | |
Mora Valley Community Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3 Mora Valley Clinic Rd, Mora, NM 87732 Phone: 575-387-5069 Fax: 575-387-9011 | |
Northeast Regional Education Cooperative Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Hwy 518 Ranger Drive, Mora, NM 87732 Phone: 505-426-2262 Fax: 505-454-1473 |