Provider Demographics
NPI:1750578159
Name:FLORES CLINIC INC
Entity type:Organization
Organization Name:FLORES CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-396-2474
Mailing Address - Street 1:PO BOX 1412
Mailing Address - Street 2:828 W JACKSON
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-1412
Mailing Address - Country:US
Mailing Address - Phone:505-396-2474
Mailing Address - Fax:505-396-5521
Practice Address - Street 1:828 W JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-3302
Practice Address - Country:US
Practice Address - Phone:505-396-2474
Practice Address - Fax:505-396-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA504-68302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42390Medicaid
NMAF6067157OtherDEA
NM42390Medicaid
NMAF6067157OtherDEA