Organization
LA CLINICA DE FAMILIA, INCORPORATED
Active
Other names
Chaparral School Base
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIL MEDINA (CEO)
(575) 526-1105
Entity
Organization
Contact information
Practice address
800 S COUNTY LINE DR, CHAPARRAL, NM 88081
(575) 525-4815
(575) 525-4816
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
321954
MEDICARE
NM
05
—
94527300
—
NM
Enumeration date
03/03/2016
Last updated
05/13/2021
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