Provider Demographics
NPI:1528581477
Name:HIPPOCARE, INC
Entity Type:Organization
Organization Name:HIPPOCARE, INC
Other - Org Name:RIO GRANDE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-433-4493
Mailing Address - Street 1:4504 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3956
Mailing Address - Country:US
Mailing Address - Phone:505-433-4493
Mailing Address - Fax:505-433-5271
Practice Address - Street 1:3911 4TH ST NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2510
Practice Address - Country:US
Practice Address - Phone:505-433-4493
Practice Address - Fax:505-433-5271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIPPOCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43575081Medicaid