Healthcare Provider Details

I. General information

NPI: 1144893249
Provider Name (Legal Business Name): SAN JUAN ONCOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 ESCALANTE DR STE 102-103
DURANGO CO
81303-8931
US

IV. Provider business mailing address

PO BOX 1799
FARMINGTON NM
87499-1799
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-9261
  • Fax: 970-828-6890
Mailing address:
  • Phone: 505-564-6850
  • Fax: 505-258-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZA THURSON
Title or Position: BILLING SPECIALIST
Credential:
Phone: 505-564-6871