Provider Demographics
NPI:1760402127
Name:SANTA FE RADIOLOGY PC
Entity Type:Organization
Organization Name:SANTA FE RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOOLPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-955-8739
Mailing Address - Street 1:1640 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4754
Mailing Address - Country:US
Mailing Address - Phone:505-983-9350
Mailing Address - Fax:505-955-8763
Practice Address - Street 1:1640 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4754
Practice Address - Country:US
Practice Address - Phone:505-955-8739
Practice Address - Fax:505-955-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0005152Medicaid
CO3107Medicare PIN
NM0005152Medicaid