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DE BACA FAMILY PRACTICE CLINIC
NPI 1114737483
Clinic/Center - Federally Qualified Health Center (FQHC) in Fort Sumner, NM

Active since January 09, 2025
546 N 10TH STREET, FORT SUMNER, NM 88119(575) 355-2414(575) 355-7894 Get Directions Write a Review

NPPES record last updated: October 14, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About De Baca Family Practice Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DE BACA FAMILY PRACTICE CLINIC (NPI 1114737483), doing business as De Baca Family Practice Clinic/mobile Unit, is a healthcare organization registered as a federally qualified health center (fqhc) in Fort Sumner, New Mexico and active in the NPI registry since January 2025. The organization lists Lisa Walraven, Ceo, as its authorized official.

NPPES Registry Identity

NPI1114737483
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameDE BACA FAMILY PRACTICE CLINIC
Location Address546 N 10TH STREETFort Sumner, NM 88119
Mailing AddressPo Box 349Fort Sumner, NM 88119-0349 · (575) 355-2414 · Fax (575) 355-7894
Phone(575) 355-2414
Fax(575) 355-7894
Organization SubpartYes
Authorized OfficialLisa WalravenCeo · (575) 355-2420
Enumeration DateJanuary 9, 2025
Last NPPES UpdateOctober 14, 2025
NPPES CertifiedOctober 14, 2025
✔ NPI 1114737483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
546 N 10TH STREET, Fort Sumner, NM 88119
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Other Names 1

Doing Business AsDe Baca Family Practice Clinic/mobile Unit

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. WIL B PACHECO DDS
Dentist (General Practice)
546 N 10TH STREET
FORT SUMNER, NM 88119
De Baca County (575) 355-2414
MS. SHEILA A SMITH LCSW
Social Worker (Clinical)
546 N 10TH STREET
FORT SUMNER, NM 88119
De Baca County (575) 355-2414
KEVIN ALAN MARTINEZ LISW
Social Worker (Clinical)
546 N 10TH STREET
FORT SUMNER, NM 88119
De Baca County (575) 355-2420
MARY ELIZABETH HETSKO DDS
Dentist
546 N 10TH STREET
FORT SUMNER, NM 88119
De Baca County (505) 355-7779

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is De Baca Family Practice Clinic's NPI number?

The NPI number for De Baca Family Practice Clinic is 1114737483. It was assigned to this organization in the NPPES registry on January 9, 2025. The provider is doing business as De Baca Family Practice Clinic/Mobile Unit.

Where is De Baca Family Practice Clinic located?

De Baca Family Practice Clinic is located at 546 N 10th Street, Fort Sumner, NM 88119. The listed phone number is (575) 355-2414.

What is De Baca Family Practice Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

When was this NPI record last updated?

The NPPES record for De Baca Family Practice Clinic was last updated on October 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.