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117 Camino De Vida 100 Santa Rosa NM 88435-2874 | |
| (575) 472-3417 | |
| (575) 472-4587 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 117 Camino De Vida, Santa Rosa, New Mexico |
| Authorized Official Name and Position | Frankie Tenorio (ADMINISTRATOR) |
| Authorized Official Contact | 5754721007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
117 Camino De Vida 100 Santa Rosa NM 88435-2874 Ph: (575) 472-3417 | 117 Camino De Vida 100 Santa Rosa NM 88435-2874 Ph: (575) 472-3417 |
| NPI Number | 1346249968 |
|---|---|
| Provider Enumeration Date | 07/15/2005 |
| Last Update Date | 01/07/2025 |
| Medicare PECOS PAC ID | 9335118918 |
|---|---|
| Medicare Enrollment ID | O20110629000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346249968 | NPI | - | NPPES |
| 7230 | Other | NM | NM DEPARTMENT OF HEALTH |
| Provider Name | Randal W Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376636159 PECOS PAC ID: 5991693525 Enrollment ID: I20060116000168 |
| Provider Name | Antje Postl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639255300 PECOS PAC ID: 4587799473 Enrollment ID: I20100317000570 |
| Provider Name | David Neil Calkins |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1407966369 PECOS PAC ID: 2163310061 Enrollment ID: I20110914000580 |
| Provider Name | Mary M Kenyon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366824963 PECOS PAC ID: 6406154913 Enrollment ID: I20160418001026 |
| Provider Name | Laura Mardo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720432271 PECOS PAC ID: 2365733318 Enrollment ID: I20160622000129 |
| Provider Name | James Gonzales |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730507955 PECOS PAC ID: 3476850116 Enrollment ID: I20170405002161 |
| Provider Name | Jesus A Tafoya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992118145 PECOS PAC ID: 5395034946 Enrollment ID: I20170819000139 |
| Provider Name | Mark L Grossetete |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447592498 PECOS PAC ID: 3577798909 Enrollment ID: I20180906001151 |
| Provider Name | Sally A Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861981193 PECOS PAC ID: 5193076172 Enrollment ID: I20181002001068 |
| Provider Name | Janoi Gonzalez Camejo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902364730 PECOS PAC ID: 8820323207 Enrollment ID: I20190708000836 |
| Provider Name | Senora L Campos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225695018 PECOS PAC ID: 4385979269 Enrollment ID: I20190715002430 |
| Provider Name | Steven T Lackey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649222910 PECOS PAC ID: 6800817776 Enrollment ID: I20190829000440 |
| Provider Name | Denia Guinart Gutierrez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568946861 PECOS PAC ID: 6002240504 Enrollment ID: I20191216001633 |
| Provider Name | Timothy W Overton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134626070 PECOS PAC ID: 1658629647 Enrollment ID: I20210610003537 |
| Provider Name | David A Phillips |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720576887 PECOS PAC ID: 7810245859 Enrollment ID: I20210802001763 |
| Provider Name | Krista N Mericle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023551363 PECOS PAC ID: 6709244593 Enrollment ID: I20230627001776 |
| Provider Name | Lyrisa Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275312191 PECOS PAC ID: 5395193049 Enrollment ID: I20231120000444 |
Sunrise Clinics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 658 S 5th St, Santa Rosa, NM 88435 Phone: 575-472-7747 Fax: 877-651-0289 | |
Sunrise Medical Group, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 552 Highway 54, Santa Rosa, NM 88435 Phone: 505-433-5572 Fax: 877-651-1259 | |
Santa Rosa Lion Care Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 717 S 3rd St, Santa Rosa, NM 88435 Phone: 505-426-2262 Fax: 505-454-1473 | |
Sunrise Clinics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 116 Camino De Vida, Santa Rosa, NM 88435 Phone: 575-472-7747 Fax: 877-651-0289 | |
Santa Rosa Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 533 Lake Dr, Santa Rosa, NM 88435 Phone: 505-472-4311 Fax: 505-472-4313 |