Provider Demographics
NPI:1851401103
Name:SANTA FE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SANTA FE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE BILLING MG
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-923-4634
Mailing Address - Street 1:7601 JEFFERSON BLVD NE
Mailing Address - Street 2:STE 340
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4496
Mailing Address - Country:US
Mailing Address - Phone:505-338-3851
Mailing Address - Fax:505-338-3859
Practice Address - Street 1:2801 RODEO RD
Practice Address - Street 2:STE B-13
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6503
Practice Address - Country:US
Practice Address - Phone:505-474-0120
Practice Address - Fax:505-474-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54443Medicaid
NM54443Medicaid