Provider Demographics
NPI:1598790222
Name:BEN ARCHER HEALTH CENTER
Entity Type:Organization
Organization Name:BEN ARCHER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-267-3280
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:626 TAFT STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NM
Practice Address - Zip Code:88029-0690
Practice Address - Country:US
Practice Address - Phone:575-531-2165
Practice Address - Fax:575-531-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6755261Q00000X
NM321871261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9358Medicaid
321871Medicare Oscar/Certification
NM=========Medicare ID - Type Unspecified