El Centro Family Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Springer, NM
NPI 1629233317 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1629233317
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 6523 (NM)
- Legal business name
- EL CENTRO FAMILY HEALTH
- Practice address
- 502 4TH Street
Springer, NM 87747 - Phone
- (575) 483-0282
- Fax
- (575) 483-0381
- NPI assigned
- Jul 23, 2008
- Organization subpart
- No
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
Practitioners 31
-
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 321862
- Legal name
- EL CENTRO FAMILY HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 1, 1996
- Last certification
- Jan 1, 1996
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1972 in NM
- Enrollment address
- 502 4TH Street
Springer, NM 87747-0487
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Paul a Guiles |
Corporate Director |
Aug 1, 2008 | |
| Sylvia a Vigil |
Corporate Director |
Jan 10, 2013 | |
| Evaristo Maestas |
Corporate Director |
Mar 1, 2009 | |
| Nesha Morse |
Corporate Director |
Dec 1, 2013 | |
| Ryan Baca |
Corporate Director |
Oct 29, 2014 | |
| Rosalie Lopez |
Corporate Director |
May 28, 2014 | |
| Lore Pease |
Corporate Officer |
Dec 15, 2008 | |
| Corporate Director |
Dec 15, 2008 | ||
| W-2 Managing Employee |
Dec 15, 2008 | ||
| Lebeo Martinez |
Corporate Director |
Dec 17, 2008 | |
| Richard C Frey |
Corporate Director |
Dec 17, 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 | |
| Lucille Montoya |
W-2 Managing Employee |
Dec 8, 1975 | |
| 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 |
|---|---|---|---|---|
| O20090113000888 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 9830080688 | Practice locations: Springer, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 6523 | NM | Yes |
Addresses
Primary practice location
502 4TH Street
Springer, NM 87747
Mailing address
538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218
Other practice location 1
403 Prospect Avenue
Springer, NM 87747
Phone (575) 483-0282
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L1947 | Medicaid | NM | |
| 1780689034 | Other | NM | ORGANIZATION NPPES |
Other providers in Springer, NM
- Samuel Blea
- Melissa Brown
- Gayle Ann Bustos
- Francesca Chavez
- Erika Derkes
- El Centro Family Health
- Stephen Evers
- First Choice Pharmacy
- Gina Marie Gamel
- Jake Gamel
All providers in Springer, 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 17, 2018. 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.