Ben Archer Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Alamogordo, NM
NPI 1902831977 · NPPES record last updated Sep 29, 2010
Key facts
- NPI
- 1902831977
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 321880 (NM)
- Legal business name
- BEN ARCHER HEALTH CENTER
- Practice address
- 2150 Highway 54 S
Alamogordo, NM 88310-7330 - Phone
- (575) 443-8133
- Fax
- (575) 443-8055
- NPI assigned
- Jul 11, 2006
- 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
Related certifications (CCN) 1
Practitioners 61
-
Denise Armfield, LCSW
-
Joy A Bell, LISW
-
Edgar Janetzko, M.D.
-
Pamela Amparano, CNP
-
Vernon Arrington, CNP
-
Marco A. Cervantes, LCSW
-
Stephen Colmant, PH.D.
-
Candace Davis, CNP
-
Rebecca L Ellis, CNP
-
Sandra Franco, FNP
-
Gloria Garcia, CNP
-
Frances E Glasscock, MSN, RN, CS
-
Lauri Greis, CNP
-
Jie Luo, M.D.
-
Raquel Neeley, M.D.
-
Andrea Ocasio, CNP
-
Ekaette Ogodo, PMHNP
-
Kam Ralston, MSN, APRN, FNP-C
-
Shannon L Rodriguez, CNS
-
Javier Salazar Jr., M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NM
Federally qualified health center certification: CCN 321880
- Legal name
- BEN ARCHER HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 5, 2000
- Last certification
- Sep 5, 2000
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 27, 1973 in NM
- Enrollment address
- 2150 Highway 54 S
Alamogordo, NM 88310-7330 - Related CCNs
- 321805
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Christina Fierro |
Corporate Director | Jan 1, 2007 | |
| Vicente Zamora |
Corporate Director | Feb 1, 2021 | |
| Mary Alice Garay |
5% Or Greater Direct Ownership Interest | Jun 1, 1993 | |
| Corporate Director | Jun 1, 1993 | ||
| W-2 Managing Employee | Jun 1, 1993 | ||
| Sylvia McGuire |
Corporate Director | Sep 1, 2012 | |
| Shawna Runyan |
Corporate Director | Feb 1, 2021 | |
| Bobby Cordero |
Corporate Director | Feb 1, 2021 | |
| Patricia Leyba |
Corporate Director | Apr 1, 2001 | |
| Elwin Roach |
Corporate Director | Jan 1, 2002 | |
| 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 |
| O20050526001068 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 7517878796 | Practice locations: Alamogordo, NM |
National Provider Directory
Locations
2150 Highway 54 S
Alamogordo, NM 88310
Phone (575) 443-8133
1998 N Motel Blvd
Las Cruces, NM 88007
Phone (575) 541-5941
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 3015 | NM | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | 321880 | NM | Yes |
Addresses
Primary practice location
2150 Highway 54 S
Alamogordo, NM 88310-7330
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B5924 | Medicaid | NM |
Other providers in Alamogordo, NM
- Candice Begay
- Behavior Change Institute, LLC.
- Logan Daniel Behrmann
- Danielle Belflower
- Constance G Bell-Mullen
- Samantha B Benfante
- Desiree Benitez
- Danyelle Benner
- Angela Senaida Bennett
- Cya Bennett
All providers in Alamogordo, 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 Sep 29, 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.