Ben Archer Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Radium Springs, NM
NPI 1770734865 · NPPES record last updated Oct 5, 2010
Key facts
- NPI
- 1770734865
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BEN ARCHER HEALTH CENTER
- Practice address
- 12080 LB Lindbeck Rd
Radium Springs, NM 88054-0419 - Phone
- (575) 267-3280
- Fax
- (575) 267-1747
- NPI assigned
- Oct 7, 2008
- Organization subpart
- No
Authorized official
- Name
- Mary Alice Garay
- Title
- Executive Director
- Phone
- (575) 267-3280
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 11
Practitioners 58
-
Marco A. Cervantes, LCSW
-
Javier Salazar Jr., M.D.
-
Felicia Ann Shipp, NURSE PRACTITIONER
-
Stephen Colmant, PH.D.
-
Rebecca L Ellis, CNP
-
Sandra Franco, FNP
-
Gloria Garcia, CNP
-
Lauri Greis, CNP
-
Michael A Jaurequi, FNP-BC
-
Clyde Kennedy Miller, M.D.
-
Raquel Neeley, M.D.
-
Shannon L Rodriguez, CNS
-
Kathleen Schuman, CNP
-
Joseph Yaroch, M.D.
-
Pamela Amparano, CNP
-
Denise Armfield, LCSW
-
Vernon Arrington, CNP
-
Joy A Bell, LISW
-
Carmen Bernal, FNP-BC
-
Candace Davis, CNP
-
Frances E Glasscock, MSN, RN, CS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NM
Federally qualified health center certification: CCN 321906
- Legal name
- BEN ARCHER HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 29, 2009
- Last certification
- Jan 29, 2009
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 29, 1973 in NM
- Enrollment address
- 12080 L B Lindbeck Rd
Radium Springs, NM 88054
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Christina Fierro |
Corporate Director | Oct 3, 2008 | |
| Vicente Zamora |
Corporate Director | Feb 1, 2021 | |
| Mary Alice Garay |
Corporate Director |
Oct 3, 2008 | |
| W-2 Managing Employee | Oct 3, 2008 | ||
| Sylvia McGuire |
Corporate Director | Feb 1, 2021 | |
| Shawna Runyan |
Corporate Director | Feb 1, 2021 | |
| Bobby Cordero |
Corporate Director | Feb 1, 2021 | |
| Patricia Leyba |
Corporate Director | Oct 3, 2008 | |
| Elwin Roach |
Corporate Director | Oct 3, 2008 | |
| Ryan Jaramillo |
Corporate Director | Feb 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031120000966 | NM | Part B Supplier - Clinic/Group Practice | 7517878796 |
Receives reassigned benefits from 92 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Truth Or Consequences, NM; Radium Springs, NM; Deming, NM; Las Cruces, NM; Columbus, NM; Hatch, NM; Alamogordo, NM |
| O20081023000585 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 7517878796 | Practice locations: Radium Springs, NM |
National Provider Directory
- Tax ID family
- Ben Archer Health Center
Locations
12080 Lindbeck Rd
Las Cruces, NM 88007
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
12080 LB Lindbeck Rd
Radium Springs, NM 88054-0419
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61359335 | Medicaid | NM |
Other providers in Radium Springs, NM
All providers in Radium Springs, 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 Oct 5, 2010. 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.