| N/a | |
|
815 W 14th St Clovis NM 88101-5514 | |
| (505) 762-6492 | |
| (505) 769-8236 |
| Full Name | N/a |
|---|---|
| Speciality | General Practice |
| Location | 815 W 14th St, Clovis, New Mexico |
| Authorized Official Name and Position | Ali M Ghaffari (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5057626492 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 815 W 14th St Clovis NM 88101-5514 Ph: (505) 762-6492 | N/a 815 W 14th St Clovis NM 88101-5514 Ph: (505) 762-6492 |
| NPI Number | 1548472830 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 10/26/2016 |
| Medicare PECOS PAC ID | 7618935206 |
|---|---|
| Medicare Enrollment ID | O20041229000549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548472830 | NPI | - | NPPES |
| S2511 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Ali M Ghaffari |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881647352 PECOS PAC ID: 9335107952 Enrollment ID: I20051208000933 |
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