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General NPI Number Information
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NPI Number | 1104142215
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Entity Type | Organization
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Legal Business Name | SAN JUAN REGIONAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 735 W ANIMAS ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5616
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Country | US
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Telephone | 505-609-6300
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Fax | 505-609-6749
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Provider Business Mailing Address
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Address Line | PO BOX 844088
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City | DALLAS
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State | TX
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Zip | 75284-4088
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Country | US
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Telephone | 505-609-2258
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Fax | 505-609-2259
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR OF REIMBURS
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Name | KIM BYRD
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Credential |
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Telephone | 505-609-2258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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