1093042632 NPI number — SANTA FE FOOT AND ANKLE INSTITUTE, LLC

Table of content: (NPI 1093042632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093042632 NPI number — SANTA FE FOOT AND ANKLE INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTA FE FOOT AND ANKLE INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093042632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2019 GALISTEO ST
Provider Second Line Business Mailing Address:
UNIT A4
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-2143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-988-3338
Provider Business Mailing Address Fax Number:
505-982-3668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2019 GALISTEO ST
Provider Second Line Business Practice Location Address:
UNIT A4
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-988-3338
Provider Business Practice Location Address Fax Number:
505-982-3668
Provider Enumeration Date:
11/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
GLENDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEMBER/OWNER
Authorized Official Telephone Number:
505-988-3338

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730266032 . This is a "IND NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 4781043 . This is a "CIGNA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: DR8662 . This is a "RR MCARE GROUP PIN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 9558062 . This is a "AETNA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 01331752 . This is a "AMERIGROUP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 85207578 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM296 . This is a "NM LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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