NPIMap

Organization Active NPI

Union County Medical Center Inc

  • Family Medicine Physician
  • Clayton, NM
National Provider Identifier
1093935355
Registry record updated Jul 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
6239 Issued in NM
Legal business name
UNION COUNTY MEDICAL CENTER INC
Practice address
314 N. 3Rd Ave
Clayton, NM 88415-0565
Phone
(575) 374-8313
Fax
(575) 374-2064
NPI assigned
Apr 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2009

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

Authorized official

Name
Mrs. Lori Van Wormer
Title
President
Phone
(575) 374-8313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 6239 NM Primary

Addresses

Primary practice location

314 N. 3Rd Ave
Clayton, NM 88415-0565

Mailing address

314 N. 3Rd Ave
Clayton, NM 88415-0565
Phone (575) 374-8313

Other identifiers 2

IdentifierTypeStateIssuer
000005645MedicaidNM
000045785MedicaidNM

Other names 1

  • Union County Medical Center PC Former legal business name

National Provider Directory

National Provider Directory

Locations

118 Walnut St
Clayton, NM 88415
Phone (575) 374-8314

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246406400000",
    "number": "1093935355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 N. 3RD AVE",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884150565",
            "telephone_number": "575-374-8313",
            "fax_number": "575-374-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 N. 3RD AVE",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884150565",
            "telephone_number": "575-374-8313",
            "fax_number": "575-374-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNION COUNTY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2009-07-01",
        "status": "A",
        "authorized_official_last_name": "VAN WORMER",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-374-8313",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "6239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000005645",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000045785",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Union County Medical Center PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clayton, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; 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.