MEDICARE: THE COMMUNITY FOUNDATION OF SOUTHERN NEW MEXICO

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	261QS1000X	Student Health Clinic/Center

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	:	1780822247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMMUNITY FOUNDATION OF SOUTHERN NEW MEXICO

Provider Business Mailing Address
First Line	:	301 S CHURCH ST
Second Line	:	STE H
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3547
Country	:	US
Telephone Number	:	575-521-4794
Fax Number	:	575-521-7325

Provider Business Practice Location Address
First Line	:	5700 MESA GRANDE
Second Line	:	ONATE HIGH SCHOOL - BASED HEALTH CLINIC
City	:	LAS CRUCES
State	:	NM
Zip	:	88012
Country	:	US
Telephone Number	:	575-527-9430
Fax Number	:	575-527-9444

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	CYNTHIA SOLUM
Credential	:
Telephone Number	:	575-521-4794

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/10/2013

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Directions to “THE COMMUNITY FOUNDATION OF SOUTHERN NEW MEXICO ” 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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