Provider Demographics
NPI:1912383001
Name:LA FAMILIA PRIMARY CARE
Entity Type:Organization
Organization Name:LA FAMILIA PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DONT KNOW
Authorized Official - Prefix:
Authorized Official - First Name:UNKNOWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-445-5563
Mailing Address - Street 1:190 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2002
Mailing Address - Country:US
Mailing Address - Phone:575-445-5563
Mailing Address - Fax:575-445-5566
Practice Address - Street 1:190 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2002
Practice Address - Country:US
Practice Address - Phone:575-445-5563
Practice Address - Fax:575-445-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-165305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75656302Medicaid
CO01224930Medicaid
NM00T6653Medicaid
COC60891Medicare PIN
NM75656302Medicaid
CO063855Medicare PIN
NM500521066Medicare PIN
CO01224930Medicaid
NM00T6653Medicaid
MIMI8833Medicare PIN