Organization · Type 2 NPI

De Baca Family Practice Clinic

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

NPI number 1114737483 Active

Practice location

546 N 10th Street
Fort Sumner, NM 88119

Call (575) 355-2414 Map

Fax (575) 355-7894

Mailing address

PO Box 349
Fort Sumner, NM 88119-0349

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

4 other providers at this address

Other federally qualified health center (fqhc) providers in Fort Sumner

De Baca Family Practice ClinicFederally Qualified Health Center (FQHC) Fort Sumner, NM NPI 1003855032
De Baca Family Practice ClinicFederally Qualified Health Center (FQHC) Fort Sumner, NM NPI 1699082644
De Baca Family Practice ClinicFederally Qualified Health Center (FQHC) Fort Sumner, NM NPI 1740090729

See all in Fort Sumner →

NPI record

NPI: 1114737483
Entity type: Organization (Type 2)
Issued: Jan 9, 2025
Last updated: Oct 14, 2025
Status: Active
Subpart: Yes of De Baca Family Practice Clinic

Other names

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De Baca Family Practice Clinic/mobile Unit · doing business as

Authorized official

Lisa Walraven
CEO
(575) 355-2420

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1114737483

De Baca Family Practice Clinic's National Provider Identifier is 1114737483, issued on Jan 9, 2025. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Fort Sumner, NM. The record was last updated on Oct 14, 2025.