Healthcare Provider Details

I. General information

NPI: 1467795336
Provider Name (Legal Business Name): FIRST NATIONS COMMUNITY HEALTHSOURCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 TRUMAN ST NE
ALBUQUERQUE NM
87110-6443
US

IV. Provider business mailing address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108-2926
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2481
  • Fax: 505-262-0781
Mailing address:
  • Phone: 52-622-4815
  • Fax: 505-262-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LINDA SON-STONE
Title or Position: CEO
Credential: CEO
Phone: 505-262-2481