Provider Demographics
NPI:1821364902
Name:FAMILY CLINIC OF NEW MEXICO
Entity Type:Organization
Organization Name:FAMILY CLINIC OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:505-881-4012
Mailing Address - Street 1:4600 JEFFERSON LN NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2134
Mailing Address - Country:US
Mailing Address - Phone:505-881-4012
Mailing Address - Fax:505-881-4883
Practice Address - Street 1:4600 JEFFERSON LN NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2134
Practice Address - Country:US
Practice Address - Phone:505-881-4012
Practice Address - Fax:505-881-4883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARCARR HOLDINGS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00453305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization