1710903844 NPI number — BEN ARCHER HEALTH CENTER

Table of content: (NPI 1710903844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710903844 NPI number — BEN ARCHER HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEN ARCHER HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710903844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATCH
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87937-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-267-3280
Provider Business Mailing Address Fax Number:
575-267-1747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 N DATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUTH OR CONSEQUENCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87901-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-894-8057
Provider Business Practice Location Address Fax Number:
575-894-4018
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARAY
Authorized Official First Name:
MARY ALICE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
575-267-3280

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  321897 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 88838307 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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