Provider Demographics
NPI:1164460507
Name:FAMILY PRACTICE ASSOCIATES OF RATON INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF RATON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEGOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-445-3626
Mailing Address - Street 1:411 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-4005
Mailing Address - Country:US
Mailing Address - Phone:505-445-3626
Mailing Address - Fax:505-445-8649
Practice Address - Street 1:411 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4005
Practice Address - Country:US
Practice Address - Phone:505-445-3626
Practice Address - Fax:505-445-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45727Medicaid
NMNM007097OtherBLUE CROSS BLUE SHEILD
CO02871769Medicaid
NM=========Medicare PIN
CO02871769Medicaid
NMNM007097OtherBLUE CROSS BLUE SHEILD