Organization
CLOVIS FAMILY HEALTH CARE CENTER LLC
Active
Other names
O'HARE WELLNESS LLC, CLOVIS FAMILY HEALTHCARE CENTER LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE O'HARE (OWNER)
(575) 760-1365
Entity
Organization
Contact information
Practice address
2301 N DR MARTIN LUTHER KING JR BLVD, CLOVIS, NM 88101-9401
(575) 762-4455
(575) 762-8411
Mailing address
2301 N MARTIN LUTHER KING BLVD, CLOVIS, NM 88101
(575) 762-4455
(575) 762-8411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3211175
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/08/2006
Last updated
06/26/2022
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