Healthcare Provider Details

I. General information

NPI: 1467625194
Provider Name (Legal Business Name): ST FRANCIS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

1494 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-7276
  • Fax: 505-983-5017
Mailing address:
  • Phone: 505-983-7276
  • Fax: 505-983-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number97-382
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number83-PA013
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2003-0017
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97-382
License Number StateNM

VIII. Authorized Official

Name: DR. LENYA REESE
Title or Position: OWNER
Credential: PAC LM
Phone: 505-983-5017