NPIMap

Organization Active NPI

Angel Fire Primary Care

  • General Practice Physician
  • Red River, NM
National Provider Identifier
1053672485
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
ANGEL FIRE PRIMARY CARE
Practice address
200 A Pioneer Road
Red River, NM 87558-0000
Phone
(575) 754-1773
Fax
(505) 989-3536
NPI assigned
Jun 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lesa D Fraker, MD
Title
President
Phone
(505) 989-8707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

200 A Pioneer Road
Red River, NM 87558-0000

Mailing address

707 Paseo de Peralta
Santa Fe, NM 87501-1922
Phone (505) 989-8707

Other names 1

  • Red River Primary Care Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338508800000",
    "number": "1053672485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 PASEO DE PERALTA",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011922",
            "telephone_number": "505-989-8707",
            "fax_number": "505-989-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 A PIONEER ROAD",
            "city": "RED RIVER",
            "state": "NM",
            "postal_code": "875580000",
            "telephone_number": "575-754-1773",
            "fax_number": "505-989-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL FIRE PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-01",
        "last_updated": "2012-06-01",
        "status": "A",
        "authorized_official_last_name": "FRAKER",
        "authorized_official_first_name": "LESA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-989-8707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red River Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Red River, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.