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2960 Rodeo Park Dr W Santa Fe NM 87505-6353 | |
(505) 986-9633 | |
(505) 820-1209 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2960 Rodeo Park Dr W, Santa Fe, New Mexico |
Authorized Official Name and Position | Doug Smith (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 5059825565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | 2960 Rodeo Park Dr W Santa Fe NM 87505-6353 Ph: (505) 986-9633 |
NPI Number | 1124134028 |
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Provider Enumeration Date | 08/22/2006 |
Last Update Date | 01/09/2021 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20101015000457 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124134028 | NPI | - | NPPES |
70298 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 3052 (New Mexico) | Primary |
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