Provider Demographics
NPI:1346476173
Name:SANTA FE CARDIOLOGY PC
Entity Type:Organization
Organization Name:SANTA FE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-992-2600
Mailing Address - Street 1:465 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-992-2600
Mailing Address - Fax:505-878-1441
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 117
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-992-2600
Practice Address - Fax:505-878-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0177207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1881627479OtherMEDICARE INDIVIDUAL NPI