Healthcare Provider Details

I. General information

NPI: 1770410532
Provider Name (Legal Business Name): SAN JUAN REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5698
US

IV. Provider business mailing address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2258
  • Fax: 505-609-2259
Mailing address:
  • Phone: 505-609-2000
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: KIM R HIPSHER-BYRD
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 505-609-2258