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DE BACA FAMILY PRACTICE CLINIC
NPI 1740090729
Clinic/Center - Federally Qualified Health Center (FQHC) in Fort Sumner, NM

Active since January 10, 2025
678 AVENUE C, FORT SUMNER, NM 88119(575) 355-2417(575) 355-2418 Get Directions Write a Review

NPPES record last updated: October 14, 2025. Verified against the NPPES registry weekly; last sync: August 02, 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 1740090729), doing business as De Baca Family Practice Clinic/dental Clinic, 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

NPI1740090729
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameDE BACA FAMILY PRACTICE CLINIC
Location Address678 AVENUE CFort Sumner, NM 88119
Mailing AddressPo Box 349Fort Sumner, NM 88119-0349 · (575) 355-2414 · Fax (575) 355-7894
Phone(575) 355-2417
Fax(575) 355-2418
Organization SubpartYes
Authorized OfficialLisa WalravenCeo · (575) 355-2420
Enumeration DateJanuary 10, 2025
Last NPPES UpdateOctober 14, 2025
NPPES CertifiedOctober 14, 2025
✔ NPI 1740090729 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedDentist · General PracticeTaxonomy 1223G0001X
678 AVENUE C, Fort Sumner, NM 88119
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Other Names 1

Doing Business AsDe Baca Family Practice Clinic/dental Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 11

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

DORENE JARAMILLO BMS
Counselor
678 AVENUE C
FORT SUMNER, NM 88119
De Baca County (575) 355-8326
PATRICIA A. SENA TREATMENT COORD
Counselor
678 AVENUE C
FORT SUMNER, NM 88119
De Baca County (575) 355-8326
TINA TEAL
Counselor
678 AVENUE C
FORT SUMNER, NM 88119
De Baca County (575) 355-8326
SHELLY RENEE LANDRETH
Counselor
678 AVENUE C
FT. SUMNER, NM 88119
De Baca County (575) 355-8326
JESICA C. TALLEY BMS
Counselor
678 AVENUE C
FORT SUMNER, NM 88119
De Baca County (575) 355-8326
BRENTON WILLIAMSON BMS
Counselor
678 AVENUE C
FT. SUMNER, NM 88119
De Baca County (575) 355-8326
ALICIA N SEGURA BMS
Counselor
678 AVENUE C
FORT SUMNER, NM 88119
De Baca County (575) 355-8326
ASTRID MARIBEL DE MATTA
Counselor
678 AVENUE C
FT. SUMNER, NM 88119
De Baca County (575) 355-8326

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 1740090729. It was assigned to this organization in the NPPES registry on January 10, 2025. The provider is doing business as De Baca Family Practice Clinic/Dental Clinic.

Where is De Baca Family Practice Clinic located?

De Baca Family Practice Clinic is located at 678 Avenue C, Fort Sumner, NM 88119. The listed phone number is (575) 355-2417.

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.