Provider Demographics
NPI:1427112473
Name:PHYSICIANS MEDICAL CENTER OF SANTA FE, LLC
Entity type:Organization
Organization Name:PHYSICIANS MEDICAL CENTER OF SANTA FE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-428-5400
Mailing Address - Street 1:2990 RODEO PARK DR EAST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6351
Mailing Address - Country:US
Mailing Address - Phone:505-428-5400
Mailing Address - Fax:505-428-5380
Practice Address - Street 1:2990 RODEO PARK DR EAST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6351
Practice Address - Country:US
Practice Address - Phone:505-428-5400
Practice Address - Fax:505-428-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM000092OtherBLUE CROSS BLUE SHEILD
NM20001878Medicaid
NM2771340OtherUNITED HEALTHCARE
NM20001878Medicaid