San Juan Regional Medical Center Inc
Organization Active NPI Pediatrics Physician · Farmington, NM
NPI 1093800534 · NPPES record last updated Jul 16, 2025
Key facts
- NPI
- 1093800534
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- SAN JUAN REGIONAL MEDICAL CENTER INC
- Practice address
- 407 S Schwartz Ave
Suite 102
Farmington, NM 87401-5925 - Phone
- (505) 609-6700
- Fax
- (505) 609-6701
- NPI assigned
- Oct 3, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SAN JUAN REGIONAL MEDICAL CENTER INC
Authorized official
- Name
- Kim Byrd
- Title
- Administrative Director of Reimburs
- Phone
- (505) 609-2258
Corporate family (same tax ID) 12
Practitioners 67
-
Kathleen M Adams, CRNA
-
Roberto Reble Bamba Jr., M.D.
-
Charles E Bruerd, D.O.
-
Keith Maxwell Bull, CRNA
-
Jessica Ann Burton-Vigil, CRNA
-
Jessica A Conklin, CNP
-
Mary Anne Domrzalski, CRNA
-
Steven B Domrzalski, CRNA
-
Darcy Ernat, CRNA
-
Christian H Felt, CRNA
-
Clarissa Gilbert, FCNP
-
David P Goldstein, M.D.
-
Jan A Gotta, M.D.
-
Jana Grossheim, CRNA
-
Chad Houghton, CRNA
-
Irwin John Isaacs, M.D.
-
Brenda James, MD
-
Maria Celina Jensen, M.D.
-
Benjamin Richard King, CRNA
-
Stephanie A Lew, CRNA
-
Janet L Margeson, CRNA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D0950152 | San Juan Health Partners Pediatrics | Certificate of waiver | Aug 18, 2026 |
National Provider Directory
- Tax ID family
- San Juan Region Med Ctr Inc
- Part of
- San Juan Region Med Ctr Inc
Locations
1970 E 3rd Ave
Ste 1
Durango, CO 81301
Phone (970) 335-2288
630 W Maple St
Farmington, NM 87401
Phone (505) 325-1123
622 W Maple St
Farmington, NM 87401
1001 W Broadway
Ste D
Farmington, NM 87401
Phone (505) 325-0238
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
407 S Schwartz Ave
Suite 102
Farmington, NM 87401-5925
Mailing address
PO Box 844088
Dallas, TX 75284-4088
Phone (505) 609-2258
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000S8021 | Medicaid | NM |
Other names
- SAN JUAN PEDIATRICS
Other providers in Farmington, NM
- San Juan Oral & Facial Surgery
- San Juan Regional Kidney Care,LLC
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
- San Juan Regional Medical Center Inc
All providers in Farmington, NM · Pediatrics Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.