Provider Demographics
NPI:1700814316
Name:SANTA FE PAIN & SPINE SPECIALISTS PC
Entity Type:Organization
Organization Name:SANTA FE PAIN & SPINE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-291-2770
Mailing Address - Street 1:PO BOX 65949
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-5949
Mailing Address - Country:US
Mailing Address - Phone:505-191-2770
Mailing Address - Fax:505-395-7551
Practice Address - Street 1:4100 HIGH RESORT BLVD SE
Practice Address - Street 2:SUITE 215
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5901
Practice Address - Country:US
Practice Address - Phone:505-191-2770
Practice Address - Fax:505-395-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0603127207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM60982811Medicaid
NM400521205Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER