Healthcare Provider Details

I. General information

NPI: 1851401103
Provider Name (Legal Business Name): SANTA FE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RODEO RD STE B-13
SANTA FE NM
87507-6503
US

IV. Provider business mailing address

7601 JEFFERSON BLVD NE STE 340
ALBUQUERQUE NM
87109-4496
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-0120
  • Fax: 505-474-4693
Mailing address:
  • Phone: 505-338-3851
  • Fax: 505-338-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ELLIOT
Title or Position: EXECUTIVE BILLING MG
Credential:
Phone: 505-923-4634