El Centro Family Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Taos, NM
NPI 1134497431 · NPPES record last updated Mar 29, 2016
Key facts
- NPI
- 1134497431
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 3516 (NM)
- Legal business name
- EL CENTRO FAMILY HEALTH
- Practice address
- 134 Cervantes St
Taos, NM 87571-6163 - Phone
- (575) 751-8032
- Fax
- (505) 753-7218
- NPI assigned
- Dec 1, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- EL CENTRO FAMILY HEALTH
Authorized official
- Name
- Mrs. Lore Pease
- Title
- Ceo
- Phone
- (505) 753-7218
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 18
Corporate family (same tax ID) 9
Practitioners 32
-
Amaya Chalker, FNP
-
Frank V. Gallegos Jr., M.D.
-
Leslie A Hayes, M.D.
-
Morgan Leigh Johnson, MPAS, PA-C
-
Wendy Johnson, MD
-
Chelsea Renee Lucero, MS LPCC
-
Veronica Michelle Martinez, FNP-C
-
Mycca S. Montoya, LMFT
-
Amber Lee Munoz, FNP-C
-
Emma Lizette Peoble, FNP
-
Tanya P. Reyes, M.D.
-
Laura Robinson, CNP
-
Ann Bosley Ruge, CNM
-
Chris B. Ruge, APRN, BC
-
Flavio F. Salazar, LISW
-
John Scott, PA
-
William B. Stanford, NP-BC
-
Germaine Concha Valdez, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Federally qualified health center certification: CCN 321932
- Legal name
- EL CENTRO FAMILY HEALTH
- Doing business as
- EL CENTRO FAMILY HEALTH TAOS HIGH SCHOOL BASED CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 10, 2014
- Last certification
- Sep 10, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1972 in NM
- Enrollment address
- 134 Cervantes Road
Taos, NM 87571-6163
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Paul a Guiles |
Corporate Director |
Aug 1, 2008 | |
| Sylvia a Vigil |
Corporate Director |
Jan 1, 2013 | |
| Evaristo Maestas |
Corporate Director |
Mar 1, 2009 | |
| Nesha Morse |
Corporate Director |
Dec 1, 2013 | |
| Rosalie Lopez |
Corporate Director |
May 28, 2014 | |
| Lebeo Martinez |
Corporate Director |
Nov 1, 1994 | |
| Darren Deyapp |
Corporate Director |
Dec 1, 2023 | |
| Richard C Frey |
Corporate Director |
Oct 1, 2008 | |
| Gary Reece |
Corporate Director |
Mar 26, 2014 | |
| Pearl Maestas |
Corporate Director |
Nov 1, 2011 | |
| Francine Kain |
Corporate Officer |
Oct 10, 2011 | |
| Lynsey Wheeler |
Corporate Director |
Aug 1, 2012 | |
| Jerome Williams |
Corporate Director |
Dec 15, 2015 | |
| Operational/Managerial Control |
Dec 15, 2015 | ||
| Sinforosa Lovato |
Corporate Director |
Feb 1, 1985 | |
| Jackie Feeler |
Corporate Director |
Feb 1, 2013 | |
| Janette Archuleta |
Corporate Director |
Mar 1, 2012 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Robertson High School Based Clinic |
Federally qualified health center | Operational/Managerial Control | Sep 7, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140912000784 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 9830080688 | Practice locations: Taos, NM |
National Provider Directory
- Tax ID family
- Health Centers of North
- Part of
- Health Centers of North
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 3516 | NM | Yes |
Addresses
Primary practice location
134 Cervantes St
Taos, NM 87571-6163
Mailing address
538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780689034 | Other | NM | NPPES |
Other names
- El Centro Family Health Taos HS SBHC
Other providers in Taos, NM
- David Edward Dyess
- Theresa Maria Dyess
- Eight Northern Indian Pueblos Council, Inc.
- Eight Northern Indian Pueblos Council, Inc.
- El Centro Family Health
- El Centro Family Health
- Meredith Benton Eley
- Robert Mills Elliott
- Travis Ely
- Melinda Encinias-Leyba
All providers in Taos, NM · Federally Qualified Health Center (FQHC) in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.