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1780689034

NPI Code Detail

MEDICARE: EL CENTRO FAMILY HEALTH

MEDICARE: EL CENTRO FAMILY HEALTH

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)	6099	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NMB2453	OTHER	NM	MEDICARE PART B PTAN

General Provider Information

NPI Number	:	1780689034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CENTRO FAMILY HEALTH

Provider Business Mailing Address
First Line	:	538 N PASEO DE ONATE
Second Line	:	P.O. BOX 158
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2618
Country	:	US
Telephone Number	:	505-753-7218
Fax Number	:	505-747-7396

Provider Business Practice Location Address
First Line	:	538 N PASEO DE ONATE
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2618
Country	:	US
Telephone Number	:	505-753-7218
Fax Number	:	505-747-7396

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LORE PEASE
Credential	:
Telephone Number	:	505-753-7218

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/12/2014

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Directions to “EL CENTRO FAMILY HEALTH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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