Organization
EL CENTRO FAMILY HEALTH
Active
Other names
Health Centers of Northern New Mexico
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORE PEASE (CEO)
(505) 753-7218
Entity
Organization
Contact information
Practice address
538 N PASEO DE ONATE, ESPANOLA, NM 87532-2618
(505) 753-7218
(505) 747-7396
Mailing address
538 N PASEO DE ONATE, P.O. BOX 158, ESPANOLA, NM 87532-2618
(505) 753-7218
(505) 747-7396
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
6099
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NMB2453
MEDICARE PART B PTAN
NM
Enumeration date
06/14/2005
Last updated
11/12/2014
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