| Mesa Family Practice Pc | |
|
2130a Farmington Ave Farmington NM 87401 | |
| (505) 325-2323 | |
| (505) 325-7172 |
| Full Name | Mesa Family Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2130a Farmington Ave, Farmington, New Mexico |
| Authorized Official Name and Position | Matthew Dekay (OWNER CEO) |
| Authorized Official Contact | 5053252323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mesa Family Practice Pc 2130a Farmington Ave Farmington NM 87401 Ph: (505) 325-2323 | Mesa Family Practice Pc 2130a Farmington Ave Farmington NM 87401 Ph: (505) 325-2323 |
| NPI Number | 1881714632 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1153312970 |
|---|---|
| Medicare Enrollment ID | O20040520001004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881714632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 95222 (New Mexico) | Primary |
| Provider Name | Matthew T Dekay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053388058 PECOS PAC ID: 9931190766 Enrollment ID: I20041022000154 |
| Provider Name | Daniel J Sabol |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1740376177 PECOS PAC ID: 4587608815 Enrollment ID: I20050817000697 |
| Provider Name | Laura S Jaquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699790881 PECOS PAC ID: 4284892100 Enrollment ID: I20120223000737 |
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