| |
465 Saint Michaels Dr # 240 Santa Fe NM 87505-7670 | |
(505) 988-1232 | |
(505) 984-1603 |
Full Name | |
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Speciality | Family Medicine |
Location | 465 Saint Michaels Dr # 240, Santa Fe, New Mexico |
Authorized Official Name and Position | Lillian Montoya (PRESIDENT CEO) |
Authorized Official Contact | 5059135201 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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465 Saint Michaels Dr Ste 230 Santa Fe NM 87505-8602 Ph: (505) 913-4710 | 465 Saint Michaels Dr # 240 Santa Fe NM 87505-7670 Ph: (505) 988-1232 |
NPI Number | 1245438647 |
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Provider Enumeration Date | 07/06/2007 |
Last Update Date | 06/11/2020 |
Medicare PECOS PAC ID | 6608775135 |
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Medicare Enrollment ID | O20240827001768 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245438647 | NPI | - | NPPES |
48853321 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Apple Long |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1992246250 PECOS PAC ID: 0648640987 Enrollment ID: I20230606002012 |
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