Provider Demographics
NPI:1770734865
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 1:12080 LB LINDBECK RD
Practice Address - Street 2:
Practice Address - City:RADIUM SPRINGS
Practice Address - State:NM
Practice Address - Zip Code:88054-0419
Practice Address - Country:US
Practice Address - Phone:575-267-3280
Practice Address - Fax:575-267-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61359335Medicaid
321906Medicare Oscar/Certification