Provider Demographics
NPI:1275239733
Name:CLOVIS FAMILY URGENT CARE LLC
Entity Type:Organization
Organization Name:CLOVIS FAMILY URGENT CARE LLC
Other - Org Name:CLOVIS FAMILY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-760-1365
Mailing Address - Street 1:2301 N DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9401
Mailing Address - Country:US
Mailing Address - Phone:575-760-1365
Mailing Address - Fax:
Practice Address - Street 1:2301 N DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9401
Practice Address - Country:US
Practice Address - Phone:575-760-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty