DE BACA FAMILY PRACTICE CLINIC – NPI #1740090729
Clinic/Center

DE BACA FAMILY PRACTICE CLINIC is an AHC clinic located in FORT SUMNER, NM. NPPES has assigned the NPI number 1740090729 to DE BACA FAMILY PRACTICE CLINIC on January 10, 2025. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was last updated on Oct 14, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for DE BACA FAMILY PRACTICE CLINIC below.

NPI Profile for
DE BACA FAMILY PRACTICE CLINIC

NPI Number
1740090729
Enumeration Date

(more than a year ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
DE BACA FAMILY PRACTICE CLINIC
Primary location
678 AVENUE C
FORT SUMNER, NM 88119
Phone: (575) 355-2417 Fax: (575) 355-2418
Mailing address
PO BOX 349
FORT SUMNER, NM 88119-0349
Phone: (575) 355-2414 Fax: (575) 355-7894
Organization Subpart
Yes - DE BACA FAMILY PRACTICE CLINIC is subpart of another organization.
Authorized Official
LISA WALRAVEN
CEO
Phone: (575) 355-2420
Updated
Certification Date
Oct 14, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)
1223G0001X
- Dentist / General Practice

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.