Healthcare Provider Details

I. General information

NPI: 1083752919
Provider Name (Legal Business Name): NORTH MAIN FAMILY HEALTH CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 N MAIN ST
LAS CRUCES NM
88001-1139
US

IV. Provider business mailing address

2611 N MAIN ST
LAS CRUCES NM
88001-1139
US

V. Phone/Fax

Practice location:
  • Phone: 505-525-3531
  • Fax: 505-525-3534
Mailing address:
  • Phone: 505-525-3531
  • Fax: 505-525-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNM8366
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNM8366
License Number StateNM

VIII. Authorized Official

Name: FAY A LAFON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-525-3531