Organization · Type 2 NPI

De Baca Family Practice Clinic

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

NPI number 1699082644 Active

Practice location

1001 Sumner Ave
Fort Sumner, NM 88119-0349

Call (575) 355-4431 Map

Fax (575) 355-4432

Mailing address

PO Box 349
Fort Sumner, NM 88119-0349

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	3069 (NM)

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

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

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

See all in Fort Sumner →

NPI record

NPI: 1699082644
Entity type: Organization (Type 2)
Issued: Sep 10, 2010
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/school Site · 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 1699082644

De Baca Family Practice Clinic's National Provider Identifier is 1699082644, issued on Sep 10, 2010. 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.