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General NPI Number Information
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NPI Number | 1487946679
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Entity Type | Organization
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Legal Business Name | SAN JUAN HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 301 SOUTH LAKE
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-564-8200
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Fax | 505-599-1838
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Provider Business Mailing Address
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Address Line | 950 WEST PINON
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-564-8200
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Fax | 505-599-1838
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Authorized Official
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Title or Position | DIRECTOR
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Name | VIRGINIA A WELLS
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Credential | RN
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Telephone | 505-564-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246QH0600X
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Taxonomy Name | Histology Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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