Healthcare Provider Details

I. General information

NPI: 1861420465
Provider Name (Legal Business Name): SANTA FE ANESTHESIA SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR SUITE 110
SANTA FE NM
87505-4728
US

IV. Provider business mailing address

PO BOX 14423
ALBUQUERQUE NM
87191-4423
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-3275
  • Fax: 505-983-4812
Mailing address:
  • Phone: 505-323-7200
  • Fax: 505-323-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0603128
License Number StateNM

VIII. Authorized Official

Name: DR. JOHN C MULLICAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-983-3275