Healthcare Provider Details

I. General information

NPI: 1437345089
Provider Name (Legal Business Name): CONCENTRA MEDICAL CENTER-SANTA FE ESPANOLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 LA JOYA ST STE. D
ESPANOLA NM
87532-2877
US

IV. Provider business mailing address

5080 SPECTRUM DR STE. 1200 WEST TOWER
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-0570
  • Fax: 505-753-1219
Mailing address:
  • Phone: 800-232-3550
  • Fax: 800-401-6728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TOM FOGARTY
Title or Position: EVP, CMO
Credential: MD
Phone: 800-232-3550