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440 Saint Michaels Dr Suite 250 Santa Fe NM 87505-7602 | |
| (505) 913-3056 | |
| (505) 989-6021 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 440 Saint Michaels Dr, Santa Fe, New Mexico |
| Authorized Official Name and Position | Bruce Tassin (PRESIDENT/CEO) |
| Authorized Official Contact | 5058205202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
440 Saint Michaels Dr Suite 250 Santa Fe NM 87505-7602 Ph: (505) 913-3056 | 440 Saint Michaels Dr Suite 250 Santa Fe NM 87505-7602 Ph: (505) 913-3056 |
| NPI Number | 1831493584 |
|---|---|
| Provider Enumeration Date | 01/10/2011 |
| Last Update Date | 02/04/2014 |
| Medicare PECOS PAC ID | 6608775135 |
|---|---|
| Medicare Enrollment ID | O20200124000988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831493584 | NPI | - | NPPES |
| 95895314 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 14-00123761 (New Mexico) | Primary |
| Provider Name | Danielle Hammons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598319246 PECOS PAC ID: 9436588951 Enrollment ID: I20200612001426 |
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