Healthcare Provider Details

I. General information

NPI: 1700178167
Provider Name (Legal Business Name): AMADOR HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE STE A
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

PO BOX 2243
LAS CRUCES NM
88004-2243
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5482
  • Fax: 575-652-4243
Mailing address:
  • Phone: 575-527-5482
  • Fax: 575-652-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6350
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA L. ANGELL
Title or Position: CEO
Credential: MPH
Phone: 575-527-5482