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NPI Code Detail

MEDICARE: BEN ARCHER HEALTH CENTER

MEDICARE: BEN ARCHER HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1699105320
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEN ARCHER HEALTH CENTER
Provider Business Mailing Address
First Line : PO BOX 370
Second Line :
City : HATCH
State : NM
Zip : 87937-0370
Country : US
Telephone Number : 575-267-3280
Fax Number : 575-267-1747
Provider Business Practice Location Address
First Line : 1955 N VALLEY DR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88007-5154
Country : US
Telephone Number : 575-267-3280
Fax Number : 575-267-1747
Authorized Official
Title or Position : FINANCIAL OFFICER
Name : JODY KOENIG
Credential :
Telephone Number : 575-267-3280
Provider Enumeration Date : 11/15/2013
Last Update Date : 11/15/2013

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Directions to “BEN ARCHER HEALTH CENTER ” Practice Location

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