NPIMap

Organization Active NPI

La Clinica de Familia, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Chaparral, NM
National Provider Identifier
1871889337
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DE FAMILIA, INCORPORATED
Practice address
510 E Lisa Dr
BLDG. 3
Chaparral, NM 88081-7809
Phone
(575) 824-0128
Fax
(575) 824-0179
NPI assigned
Jun 23, 2011
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Virgil Medina
Title
Chief Executive Officer
Phone
(575) 526-1105

National Provider Directory

National Provider Directory
Tax ID family
La Clinica de Familia48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

510 E Lisa Dr
Bldg 3
Chaparral, NM 88081
Phone (575) 824-0128

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NM Primary

Addresses

NPPES NPI Registry

Primary practice location

510 E Lisa Dr
BLDG. 3
Chaparral, NM 88081-7809

Mailing address

385 Calle de Alegra
BLDG. a
Las Cruces, NM 88005-3423
Phone (575) 526-1105

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
66234743MedicaidNM

Other names 1

NPPES NPI Registry
  • La Clinica De Familia Chaparral Dental Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 13, 2021.

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1871889337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 CALLE DE ALEGRA",
            "address_2": "BLDG. A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053423",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E LISA DR",
            "address_2": "BLDG. 3",
            "city": "CHAPARRAL",
            "state": "NM",
            "postal_code": "880817809",
            "telephone_number": "575-824-0128",
            "fax_number": "575-824-0179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE FAMILIA, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-23",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "575-526-1105"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66234743",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica De Familia Chaparral Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Clinica De Familia Chaparral Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chaparral, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.