Provider Demographics
NPI:1225162266
Name:ADULT MEDICINE SPECIALISTS OF SANTA FE
Entity Type:Organization
Organization Name:ADULT MEDICINE SPECIALISTS OF SANTA FE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOUDINOT
Authorized Official - Middle Name:TALCOTT
Authorized Official - Last Name:ATTERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-989-7400
Mailing Address - Street 1:1650 HOSPITAL DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4769
Mailing Address - Country:US
Mailing Address - Phone:505-989-7400
Mailing Address - Fax:505-986-8028
Practice Address - Street 1:1650 HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4769
Practice Address - Country:US
Practice Address - Phone:505-989-7400
Practice Address - Fax:505-986-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM0931OtherBCBS OF NEW MEXICO
NMNM013461OtherBCBS OF NEW MEXICO
NM30751Medicaid
NMK8459Medicaid
NMG36340Medicare UPIN
NM30751Medicaid