MEDICARE: SANTA FE PAIN & SPINE SPECIALISTS PC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	0603127	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	:	1700814316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA FE PAIN & SPINE SPECIALISTS PC

Provider Business Mailing Address
First Line	:	PO BOX 65949
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87193-5949
Country	:	US
Telephone Number	:	505-191-2770
Fax Number	:	505-395-7551

Provider Business Practice Location Address
First Line	:	4100 HIGH RESORT BLVD SE
Second Line	:	SUITE 215
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-5901
Country	:	US
Telephone Number	:	505-191-2770
Fax Number	:	505-395-7551

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	ANDREA ACOSTA
Credential	:
Telephone Number	:	505-291-2770

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/25/2016

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Directions to “SANTA FE PAIN & SPINE SPECIALISTS PC ” Practice Location

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