NPI 1114737483

De Baca Family Practice Clinic

Organisation Federally Qualified Health Center (FQHC) Fort Sumner, NM

Practice location

Address: 546 N 10th Street, Fort Sumner, NM 88119
Phone: (575) 355-2414
Fax: (575) 355-7894
Mailing address: PO Box 349, Fort Sumner, NM 88119-0349

Authorised official

Name: Lisa Walraven
Title: Ceo
Phone: (575) 355-2420

Registered specialties

Federally Qualified Health Center (FQHC) Primary

Ambulatory Health Care Facilities Taxonomy 261QF0400X

Other Clinic/Center providers in New Mexico →

Registry record

NPI: 1114737483
Entity type: Organization
NPI issued: 9 Jan 2025
Record last updated: 14 Oct 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.