| NPI | 1902993132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH DYE CEO 505-241-5182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2024-10-17 |