MEDICARE: LA CLINICA DE FAMILIA, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	321951	OTHER	NM	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689034662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA CLINICA DE FAMILIA, INCORPORATED

Provider Business Mailing Address
First Line	:	385 CALLE DE ALEGRA
Second Line	:	BLDG. A
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3423
Country	:	US
Telephone Number	:	575-526-1105
Fax Number	:	575-524-4266

Provider Business Practice Location Address
First Line	:	6301 NM HIGHWAY 28
Second Line	:
City	:	ANTHONY
State	:	NM
Zip	:	88021
Country	:	US
Telephone Number	:	575-525-4817
Fax Number	:	575-525-4818

Authorized Official
Title or Position	:	CEO
Name	:	VIRGIL MEDINA
Credential	:
Telephone Number	:	575-526-1105

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	01/27/2026

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Directions to “LA CLINICA DE FAMILIA, INCORPORATED ” Practice Location

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