Organization
LA CLINICA DE FAMILIA, INCORPORATED
Active
Other names
La clinica De Familia Santa Teresa School Base
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIL MEDINA (CHIEF EXECUTIVE OFFICER)
(575) 526-1105
Entity
Organization
Contact information
Practice address
100 AIRPORT RD, SANTA TERESA, NM 88008-9703
(575) 874-9338
(575) 874-9338
Mailing address
385 CALLE DE ALEGRA, BLDG. A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
321946
MEDICARE
NM
05
—
94479712
—
NM
Enumeration date
02/09/2006
Last updated
05/13/2021
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