MEDICARE: NEW MEXICO DEPARTMENT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	E6603	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619197506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	1190 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4173
Country	:	US
Telephone Number	:	505-827-0015
Fax Number	:	505-827-0021

Provider Business Practice Location Address
First Line	:	1190 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4173
Country	:	US
Telephone Number	:	505-827-0015
Fax Number	:	505-827-0021

Authorized Official
Title or Position	:	DENTAL DIRECTOR
Name	:	DR. KENNETH JOHN PADILLA
Credential	:	D.D.S.
Telephone Number	:	505-827-0015

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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Directions to “NEW MEXICO DEPARTMENT OF HEALTH ” Practice Location

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