Healthcare Provider Details

I. General information

NPI: 1285613836
Provider Name (Legal Business Name): SANTA FE INDIAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CERRILLOS RD
SANTA FE NM
87505-3554
US

IV. Provider business mailing address

1700 CERRILLOS RD
SANTA FE NM
87505-3554
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-9821
  • Fax: 505-983-6243
Mailing address:
  • Phone: 505-988-9821
  • Fax: 505-983-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL SANDOVAL
Title or Position: ACCOUNTING
Credential:
Phone: 505-988-9821