NPIMap

Organization Active NPI

Clovis Family Healthcare Center LLC

Doing business as Encore Express Care

  • Family Medicine Physician
  • Clovis, NM
National Provider Identifier
1356401830
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A112299 Issued in NM
Legal business name
CLOVIS FAMILY HEALTHCARE CENTER LLC
Doing business as
Encore Express Care
Practice address
2301 N MLK Blvd
Clovis, NM 88101-9401
Phone
(505) 762-4455
Fax
(505) 763-4029
NPI assigned
Dec 12, 2006
Last updated
Jan 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

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

Authorized official

Name
Amanda Shrader
Title
Owner
Phone
(575) 762-4455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A112299 NM Primary

Addresses

Primary practice location

2301 N MLK Blvd
Clovis, NM 88101-9401

Mailing address

2301 N MLK Blvd
Clovis, NM 88101-9401
Phone (505) 762-4455

Other practice location 1

912 W 21st St
Clovis, NM 88101
Phone (505) 762-4455

Other identifiers 1

IdentifierTypeStateIssuer
62706501MedicaidNM

Other names 1

  • Encore Express Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clovis Family Health Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1356401830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 N MLK BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401",
            "telephone_number": "505-762-4455",
            "fax_number": "505-763-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N MLK BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401",
            "telephone_number": "505-762-4455",
            "fax_number": "505-763-4029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "912 W 21st St",
            "address_purpose": "LOCATION",
            "city": "Clovis",
            "state": "NM",
            "postal_code": "88101",
            "country_code": "US",
            "telephone_number": "505-762-4455",
            "fax_number": "505-763-4029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLOVIS FAMILY HEALTHCARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "SHRADER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-762-4455"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "A112299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62706501",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Encore Express Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Encore Express Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.