Provider Demographics
NPI:1700178167
Name:AMADOR HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:AMADOR HEALTH CENTER, INC.
Other - Org Name:ST. LUKE'S HEALTH CARE CLINIC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:575-527-5482
Mailing Address - Street 1:PO BOX 2243
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2243
Mailing Address - Country:US
Mailing Address - Phone:575-527-5482
Mailing Address - Fax:575-652-4243
Practice Address - Street 1:999 W AMADOR AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2739
Practice Address - Country:US
Practice Address - Phone:575-527-5482
Practice Address - Fax:575-652-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6350261Q00000X
261QC1500X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76632873Medicaid