NPIMap

Organization Active NPI

Clovis Family Health Care Center LLC

  • Family Medicine Physician
  • Clovis, NM
National Provider Identifier
1760123475
Registry record updated Jun 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLOVIS FAMILY HEALTH CARE CENTER LLC
Doing business as
Clovis Family Healthcare Center LLC
Practice address
2301 N Dr Martin Luther King Jr Blvd
Clovis, NM 88101-9401
Phone
(575) 762-4455
NPI assigned
Apr 5, 2022
Last updated
Jun 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2022

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

Authorized official

Name
Blake O'Hare
Title
Owner
Phone
(575) 760-1365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2301 N Dr Martin Luther King Jr Blvd
Clovis, NM 88101-9401

Mailing address

PO Box 1087
Clovis, NM 88102-1087
Phone (575) 760-1365

Other names 2

  • CLOVIS FAMILY HEALTHCARE CENTER LLC Doing business as
  • O'Hare Wellness LLC Other name

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.

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656201600000",
    "number": "1760123475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1087",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881021087",
            "telephone_number": "575-760-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N DR MARTIN LUTHER KING JR BLVD",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019401",
            "telephone_number": "575-762-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVIS FAMILY HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-06-26",
        "certification_date": "2022-06-26",
        "status": "A",
        "authorized_official_last_name": "O'HARE",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-760-1365"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLOVIS FAMILY HEALTHCARE CENTER LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "O'Hare Wellness LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 26, 2022; 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.