32D0537331 CLIA NUMBER - DE BACA FAMILY PRACTICE CLINIC

Laboratory Demographics

  • CLIA Code: 32D0537331
  • Facility Name: DE BACA FAMILY PRACTICE CLINIC
  • Facility Address: 546 N 10TH ST
    FORT SUMNER, NM
    ZIP 88119
  • Facility Phone: 575 355-2450
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Certificate of Compliance
  • Lab Director: JACK VICK
  • NPI Number: 1962743534
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 32D0537331
LAB Type Federally Qualified Health Center
Facility Name DE BACA FAMILY PRACTICE CLINIC
Street 546 N 10TH ST
City FORT SUMNER
State NM
ZIP 88119
Phone 575 355-2450
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type Federally Qualified Health Center
Lab Director JACK VICK

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This page was last updated on: 9/29/2025