Ben Archer Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Deming, NM
NPI 1194443135 · NPPES record last updated Aug 16, 2022
Key facts
- NPI
- 1194443135
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BEN ARCHER HEALTH CENTER
- Practice address
- 1300 S Iron St
Deming, NM 88030-5040 - Phone
- (575) 543-1017
- Fax
- (575) 544-0115
- NPI assigned
- Aug 16, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- BEN ARCHER HEALTH CENTER
Authorized official
- Name
- Mary Alice Garay
- Title
- Executive Director
- Phone
- (575) 267-3280
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 11
Practitioners 108
-
Pamela Amparano, CNP
-
Vernon Arrington, CNP
-
Carmen Bernal, FNP-BC
-
Stephen Colmant, PH.D.
-
Candace Davis, CNP
-
Rebecca L Ellis, CNP
-
Sandra Franco, FNP
-
Gloria Garcia, CNP
-
Lauri Greis, CNP
-
Edgar Janetzko, M.D.
-
Michael A Jaurequi, FNP-BC
-
Kimberly A Lunar, CNP
-
Jie Luo, M.D.
-
Robert C Mayfield, PH. D
-
Deanna Naugle, PA-C
-
Raquel Neeley, M.D.
-
Andrea Ocasio, CNP
-
Ekaette Ogodo, PMHNP
-
Kam Ralston, MSN, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Federally qualified health center certification: CCN 321975
- Legal name
- BEN ARCHER HEALTH CENTER
- Doing business as
- BEN ARCHER HEALTH CENTER DEMING SCHOOL BASE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 29, 2022
- Last certification
- Aug 29, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 29, 1973 in NM
- Enrollment address
- 1300 S Iron St
Deming, NM 88030-5040
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Christina Fierro |
Corporate Director |
Jan 1, 2007 | |
| Vicente Zamora |
Corporate Director |
Dec 17, 2017 | |
| Mary Alice Garay |
Corporate Officer |
Nov 15, 2013 | |
| W-2 Managing Employee |
Mar 5, 1985 | ||
| Sylvia McGuire |
Corporate Director |
Sep 27, 2012 | |
| Shawna Runyan |
Corporate Director |
Jan 1, 2020 | |
| Erika Hernandez |
W-2 Managing Employee |
May 3, 2021 | |
| Bobby Cordero |
Corporate Director |
Jan 1, 2021 | |
| Patricia Leyba |
Corporate Director |
Apr 1, 2001 | |
| Elwin Roach |
Corporate Director |
Jan 20, 2002 | |
| Rebecca Olivas |
Corporate Officer |
Feb 1, 2021 | |
| W-2 Managing Employee |
Oct 6, 2008 | ||
| Ryan Jaramillo |
Corporate Director |
Mar 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221007002115 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 7517878796 | Practice locations: Deming, NM |
National Provider Directory
- Tax ID family
- Ben Archer Health Center
- Part of
- Ben Archer Health Center
Locations
1300 S Iron St
Deming, NM 88030
Phone (575) 543-1017
1950 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-8057
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1300 S Iron St
Deming, NM 88030-5040
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280
Other names
- Ben Archer Health Center Deming School Base
Other providers in Deming, NM
- Margo J. Baca
- Bianca L Baeza-Holguin
- Casandra Alicia Barba
- Beautify LLC
- Megan Gail Bell
- Ben Archer Health Center
- Bestcare Pharmacy Deming
- Braeden Blandford
- Blue Skies Health Care, Inc
- Blue Skies Primary Care PC
All providers in Deming, 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 Aug 16, 2022. 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.