| San Juan Health And Wellness Center | |
|
4801 N Butler Ave Ste 1101 Farmington NM 87401-1013 | |
| (505) 327-0002 | |
| (505) 325-9443 |
| Full Name | San Juan Health And Wellness Center |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4801 N Butler Ave, Farmington, New Mexico |
| Authorized Official Name and Position | Misty Dawn Diaz (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 5053270002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Juan Health And Wellness Center 4801 N Butler Ave Ste 1101 Farmington NM 87401-1013 Ph: (505) 327-0002 | San Juan Health And Wellness Center 4801 N Butler Ave Ste 1101 Farmington NM 87401-1013 Ph: (505) 327-0002 |
| NPI Number | 1568998029 |
|---|---|
| Provider Enumeration Date | 05/03/2017 |
| Last Update Date | 12/29/2023 |
| Certification Date | 11/13/2023 |
| Medicare PECOS PAC ID | 4284905308 |
|---|---|
| Medicare Enrollment ID | O20170809000144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568998029 | NPI | - | NPPES |
| 86337556 | Medicaid | NM | |
| 2782 | Other | NM | LAST FOUR OF TIN |
| Provider Name | Kelly M Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245679000 PECOS PAC ID: 8123253234 Enrollment ID: I20131025001608 |
| Provider Name | Matthew K Greenwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033680566 PECOS PAC ID: 2860733177 Enrollment ID: I20190416000113 |
| Provider Name | Eva Jean Morales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104184019 PECOS PAC ID: 3274862511 Enrollment ID: I20190911001389 |
| Provider Name | Thomas L Mccolloch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588663322 PECOS PAC ID: 9931105541 Enrollment ID: I20191018001523 |
| Provider Name | Joanna Beth Dominick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174788145 PECOS PAC ID: 9436205077 Enrollment ID: I20200114000573 |
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Diane W Williams Psyd Pc D/b/a Integrative Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3001 Northridge Dr Ste A, Farmington, NM 87401 Phone: 505-327-3145 | |
Presbyterian Medical Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 851 Andrea Dr, Suite 4, Building E, Farmington, NM 87401 Phone: 505-324-5855 Fax: 505-324-5896 | |
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