La Clinica de Familia, Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Mesilla, NM
NPI 1528443967 · NPPES record last updated May 13, 2021
Key facts
- NPI
- 1528443967
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LA CLINICA DE FAMILIA, INCORPORATED
- Practice address
- 2355 Avendia de Mesilla
Mesilla, NM 88046 - Phone
- (575) 526-1105
- Fax
- (575) 524-4266
- NPI assigned
- Jul 28, 2015
- Organization subpart
- No
Authorized official
- Name
- Virgil Medina
- Title
- Ceo
- Phone
- (575) 526-1105
Owned or controlled facilities with NPI records 6
Other NPIs with the same Medicare PAC ID 19
Corporate family (same tax ID) 47
Practitioners 70
-
Eva Pavia Aguilar, FNP
-
Morgan R Alexander, CNM
-
Oscar Alvarez-Reyes, LMFT
-
Edward Rudy Alvarez, LMHC
-
John Andazola, M.D.
-
Cristina Apodaca, LMHC
-
Daniel Armistead, M.D
-
Maria Inez Bagwell, LCSW, LADAC
-
Gaston Alberto Berrios, M.D.
-
Rosalva Blanco, LCSW
-
Tammi Bone, CNP
-
Yvette Borde, CNM
-
Jacquelyn Brito, MD
-
Berenice Cangas, LMHC
-
Eliseo Cisneros, LMFT
-
Alison L. Clark, CNM
-
Amelia Clement, MD
-
Amanda Curry, LCSW
-
Linda Enriquez, LMHC
-
Jose Leos Flores, MD
-
Marva Selene Fonseca, LMHC
-
Amelia Louise Furrow, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Federally qualified health center certification: CCN 321945
- Legal name
- LA CLINICA DE FAMILIA INCORPORATED
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 27, 2016
- Last certification
- Jul 27, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 12, 1978 in NM
- Enrollment address
- 2355 Avenida de Mesilla
Mesilla, NM 88046
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Virgil Medina |
Corporate Officer |
Apr 28, 2017 | |
| W-2 Managing Employee |
Apr 28, 2017 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| LCDF Gadsden School Base |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2016 |
| La Clinica de Familia Incorporated |
Federally qualified health center | Operational/Managerial Control | Jul 1, 2016 |
| La Clinica de Familia Incorporated |
Federally qualified health center | Operational/Managerial Control | Oct 22, 2019 |
| Picacho Middle School - School Base Health Center |
Federally qualified health center | Operational/Managerial Control | Jul 12, 2023 |
| Mayfield High School - School Based Health Center |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2025 |
| Organ Mountain High School - School Based Health Center |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160728000199 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 6305745191 | Practice locations: Mesilla, NM |
National Provider Directory
- Tax ID family
- La Clinica de Familia
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2355 Avendia de Mesilla
Mesilla, NM 88046
Mailing address
385 Calle de Alegra
BLDG. a
Las Cruces, NM 88005-3423
Phone (575) 526-1105
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 321945 | Other | NM | MEDICARE |
| 52334520 | Medicaid | NM |
Other names
- Rio Grande School Base
Other providers in Mesilla, NM
- Arbol de la Vida Psychological Services, LLC
- Amanda Buras
- Virginia Longoria
- Richard Lucero
- Terry Lucero
- Nathaniel Michael May
- New Neural Pathways
All providers in Mesilla, 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 May 13, 2021. 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.