OrganizationActive
De Baca Family Practice Clinic
NPI 1740090729 · Federally Qualified Health Center (FQHC) · Fort Sumner, NM
Provider details
- NPI number
- 1740090729
- Entity type
- Organization
- Primary specialty
- Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
- Parent organization
- De Baca Family Practice Clinic
- Organization subpart
- Yes
- Authorized official
- Lisa Walraven, Ceo(575) 355-2420
Specialties & taxonomies
Ambulatory Health Care Facilities
- General Practice Dentistry1223G0001X
Dental Providers
Practice location
678 Avenue C
Fort Sumner, NM 88119
Phone: (575) 355-2417
Fax: (575) 355-2418
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 349
Fort Sumner, NM 88119-0349
Other names (DBA / former)
- Doing business as
- De Baca Family Practice Clinic/Dental Clinic
Registry dates
- Enumerated
- 2025-01-10
- Last updated
- 2025-10-14
- Certified
- 2025-10-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.