| Mesa Vista Wellness | |
|
4001 Office Court Dr Ste 102 Santa Fe NM 87507-4903 | |
| (505) 983-8225 | |
| Not Available |
| Full Name | Mesa Vista Wellness |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4001 Office Court Dr Ste 102, Santa Fe, New Mexico |
| Authorized Official Name and Position | Tod L Dicecco (EXECUTIVE DIRECTOR/OWNER) |
| Authorized Official Contact | 5054901984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mesa Vista Wellness 4001 Office Court Dr Suite 102 Santa Fe NM 87507-4929 Ph: (505) 983-8225 | Mesa Vista Wellness 4001 Office Court Dr Ste 102 Santa Fe NM 87507-4903 Ph: (505) 983-8225 |
| NPI Number | 1447490800 |
|---|---|
| Provider Enumeration Date | 02/25/2009 |
| Last Update Date | 02/10/2022 |
| Certification Date | 02/10/2022 |
| Medicare PECOS PAC ID | 4183907850 |
|---|---|
| Medicare Enrollment ID | O20170203002518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447490800 | NPI | - | NPPES |
| 81024371 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0119891 (New Mexico) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Hal M Agler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558409060 PECOS PAC ID: 3678797909 Enrollment ID: I20140606001010 |
| Provider Name | Rhonda Albin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235347139 PECOS PAC ID: 8123252665 Enrollment ID: I20170413001222 |
| Provider Name | Shaia L D'ourso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316281363 PECOS PAC ID: 8224314745 Enrollment ID: I20170418002379 |
| Provider Name | Sarah J Barnard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477016590 PECOS PAC ID: 5799028106 Enrollment ID: I20190528000199 |
| Provider Name | Heather Hines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831549955 PECOS PAC ID: 9931434263 Enrollment ID: I20190709002638 |
| Provider Name | Scott A Temple |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497146690 PECOS PAC ID: 0143652263 Enrollment ID: I20191112000413 |
| Provider Name | Molly Leach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710389754 PECOS PAC ID: 0345673265 Enrollment ID: I20191209000187 |
| Provider Name | Mindy A Mcclung |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134598303 PECOS PAC ID: 0345675591 Enrollment ID: I20200115002149 |
| Provider Name | Amy E Elmquist |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588127781 PECOS PAC ID: 2163859331 Enrollment ID: I20200227002369 |
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