MEDICARE: AMADOR HEALTH CENTER, INC.

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	261Q00000X	Clinic/Center	6350	NM
2	261QC1500X	Community Health Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1700178167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMADOR HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2243
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88004-2243
Country	:	US
Telephone Number	:	575-527-5482
Fax Number	:	575-652-4243

Provider Business Practice Location Address
First Line	:	999 W AMADOR AVE STE A
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2739
Country	:	US
Telephone Number	:	575-527-5482
Fax Number	:	575-652-4243

Authorized Official
Title or Position	:	CEO
Name	:	MS. PAMELA L. ANGELL
Credential	:	MPH
Telephone Number	:	575-527-5482

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	08/29/2024

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Directions to “AMADOR HEALTH CENTER, INC. ” Practice Location

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