Healthcare Provider Details

I. General information

NPI: 1831274851
Provider Name (Legal Business Name): SAN FELIPE HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CEDAR STREET
SAN FELIPE NM
87001
US

IV. Provider business mailing address

PO BOX 4344
SAN FELIPE PB NM
87001-4344
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-5485
  • Fax: 505-867-6527
Mailing address:
  • Phone: 505-867-6527
  • Fax: 505-867-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH1232
License Number StateNM

VIII. Authorized Official

Name: ROBERT LYON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-988-9821