| Sastun Family Medicine, Llc | |
|
2019 Galisteo St Suite N9a Santa Fe NM 87505-2143 | |
| (505) 988-1930 | |
| (505) 982-9931 |
| Full Name | Sastun Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2019 Galisteo St, Santa Fe, New Mexico |
| Authorized Official Name and Position | Paul R Dodge (OWNER/COO) |
| Authorized Official Contact | 5054690516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sastun Family Medicine, Llc 2019 Galisteo St Suite N9a Santa Fe NM 87505-2143 Ph: (505) 988-1930 | Sastun Family Medicine, Llc 2019 Galisteo St Suite N9a Santa Fe NM 87505-2143 Ph: (505) 988-1930 |
| NPI Number | 1891100814 |
|---|---|
| Provider Enumeration Date | 06/27/2014 |
| Last Update Date | 07/17/2016 |
| Medicare PECOS PAC ID | 7719209535 |
|---|---|
| Medicare Enrollment ID | O20141206000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891100814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rita J Dodge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114076650 PECOS PAC ID: 1759355076 Enrollment ID: I20040823001222 |
| Provider Name | Sze Kim Pang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669597076 PECOS PAC ID: 1951444652 Enrollment ID: I20140814000943 |
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