Healthcare Provider Details

I. General information

NPI: 1205861283
Provider Name (Legal Business Name): BEN ARCHER HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHAPARREL BLVD NW
DEMING NM
88030-8629
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-4800
  • Fax: 575-546-0685
Mailing address:
  • Phone: 575-267-3280
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3175
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number321893
License Number StateNM

VIII. Authorized Official

Name: MARY ALICE GARAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-267-3280