| NPI | 1922269117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH M DYE CEO 505-459-8321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2025-12-18 |