Healthcare Provider Details

I. General information

NPI: 1326440074
Provider Name (Legal Business Name): SANTA FE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S SANTA CLARA BRIDGE RD
ESPANOLA NM
87532-9477
US

IV. Provider business mailing address

7601 JEFFERSON ST NE STE 340
ALBUQUERQUE NM
87109-4494
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-6939
  • Fax: 505-747-6816
Mailing address:
  • Phone: 505-338-3851
  • Fax: 505-338-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP D BRIGGS
Title or Position: OWNER
Credential: MD
Phone: 505-338-3851