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2145 Caja Del Oro Grant Rd Santa Fe NM 87507-3279 | |
| (505) 438-3195 | |
| (505) 982-6280 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2145 Caja Del Oro Grant Rd, Santa Fe, New Mexico |
| Authorized Official Name and Position | Brandon Vanessa Van Pelt (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5059824425 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2145 Caja Del Oro Grant Rd Santa Fe NM 87507-3279 Ph: (505) 982-4415 | 2145 Caja Del Oro Grant Rd Santa Fe NM 87507-3279 Ph: (505) 438-3195 |
| NPI Number | 1710049218 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 01/13/2025 |
| Medicare PECOS PAC ID | 4082601026 |
|---|---|
| Medicare Enrollment ID | O20090212000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710049218 | NPI | - | NPPES |
| B3367 | Medicaid | NM |
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