DE BACA FAMILY PRACTICE CLINIC

FORT SUMNER, NM
NPI1699082644
Doing Business AsDE BACA FAMILY PRACTICE CLINIC/SCHOOL SITE
Entity TypeOrganization
Authorized ContactLISA WALRAVEN
CEO
575-355-2420
Organization Subpart ?Yes
Primary Taxonomy261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC)
(Licence: NM  3069)
Enumeration Date2010-09-10
Last Update Date2025-10-14
Business Address
DE BACA FAMILY PRACTICE CLINIC
1001 SUMNER AVE
FORT SUMNER, NM 88119-0349
Phone number: 575-355-4431
Mailing Address
DE BACA FAMILY PRACTICE CLINIC
PO BOX 349
FORT SUMNER, NM 88119-0349
Phone number: 575-355-2414
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DE BACA FAMILY PRACTICE CLINIC
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