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General NPI Number Information
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NPI Number | 1558454678
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Entity Type | Organization
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Legal Business Name | SAN JUAN ENDOSCOPY LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 950 W PINON ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5905
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Country | US
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Telephone | 803-252-7979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1974
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City | FARMINGTON
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State | NM
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Zip | 87499-1974
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GEORGE PAYNE
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Credential | MD
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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 | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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