=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083752919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH MAIN FAMILY HEALTH CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2611 N MAIN ST
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88001-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-525-3531
-----------------------------------------------------
Fax | 505-525-3534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2611 N MAIN ST
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88001-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-525-3531
-----------------------------------------------------
Fax | 505-525-3534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FAY A LAFON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 505-525-3531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | NM8366
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | NM8366
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------