Provider Demographics
NPI:1982854857
Name:ANASAZI MEDICAL ASSOCAITES PA
Entity Type:Organization
Organization Name:ANASAZI MEDICAL ASSOCAITES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:505-473-0390
Mailing Address - Street 1:2055 S PACHECO ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3997
Mailing Address - Country:US
Mailing Address - Phone:505-473-0390
Mailing Address - Fax:505-473-0375
Practice Address - Street 1:2055 S PACHECO ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3997
Practice Address - Country:US
Practice Address - Phone:505-473-0390
Practice Address - Fax:505-473-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0043363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty