Provider Demographics
NPI:1063573509
Name:SANDIA HEALTH CENTER
Entity type:Organization
Organization Name:SANDIA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-248-4062
Mailing Address - Street 1:801 VASSAR DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2725
Mailing Address - Country:US
Mailing Address - Phone:505-248-7711
Mailing Address - Fax:505-248-7701
Practice Address - Street 1:481 SANDIA LOOP
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-7076
Practice Address - Country:US
Practice Address - Phone:505-867-4487
Practice Address - Fax:505-771-5126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBUQUERQUE INDIAN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMHSZ164OtherGROUP
NMH7890Medicaid
NMHSZ164OtherGROUP