| Caroline Kingston Md Mph Family Prectice Llc | |
|
460 Saint Michaels Dr 1204 Santa Fe NM 87505-7619 | |
| (505) 820-2562 | |
| (505) 986-0904 |
| Full Name | Caroline Kingston Md Mph Family Prectice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 460 Saint Michaels Dr, Santa Fe, New Mexico |
| Authorized Official Name and Position | Caroline Kingston (DR.) |
| Authorized Official Contact | 5058202562 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caroline Kingston Md Mph Family Prectice Llc 460 Saint Michaels Dr 1204 Santa Fe NM 87505-7619 Ph: (505) 820-2562 | Caroline Kingston Md Mph Family Prectice Llc 460 Saint Michaels Dr 1204 Santa Fe NM 87505-7619 Ph: (505) 820-2562 |
| NPI Number | 1194966747 |
|---|---|
| Provider Enumeration Date | 03/11/2009 |
| Last Update Date | 12/23/2009 |
| Medicare PECOS PAC ID | 0143361998 |
|---|---|
| Medicare Enrollment ID | O20091231000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194966747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 97-89 (New Mexico) | Primary |
| Provider Name | Caroline Kingston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750489811 PECOS PAC ID: 8426199274 Enrollment ID: I20091231000102 |
| Provider Name | Michael Ryan Brison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942756630 PECOS PAC ID: 4082996228 Enrollment ID: I20170123001733 |
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