Provider Demographics
NPI:1841626850
Name:SANTA FE MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:SANTA FE MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-944-9414
Mailing Address - Street 1:3600 RODEO LN
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6400
Mailing Address - Country:US
Mailing Address - Phone:505-474-6097
Mailing Address - Fax:505-471-4503
Practice Address - Street 1:2801 RODEO RD
Practice Address - Street 2:SUITE 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:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13-00054443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty