San Juan Regional Medical Center Inc
Organization Active NPI Surgery Physician · Farmington, NM
NPI 1104142215 · NPPES record last updated Jul 16, 2025
Key facts
- NPI
- 1104142215
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- SAN JUAN REGIONAL MEDICAL CENTER INC
- Practice address
- 735 W Animas St
Farmington, NM 87401-5616 - Phone
- (505) 609-6300
- Fax
- (505) 609-6749
- NPI assigned
- Apr 14, 2010
- Organization subpart
- No
Authorized official
- Name
- Kim Byrd
- Title
- Administrative Director of Reimburs
- Phone
- (505) 609-2258
Other NPIs on the same Medicare enrollment 18
Practitioners 41
-
Christine Boehringer, D.O.
-
James M Boyd, MD
-
Reece Leland Boyd, M.D.
-
Anna Victoria Buck, FNP
-
David Alan Dunworth, D.O.
-
Candace Esther Flores, APRN-CNP
-
Shawna M Frost, NP
-
Markus E Garard, MD
-
Dwayne L Gibbs, M.D.
-
Lori B Golzar, CNP
-
Charles Hoffman, MD
-
Savanna Dru Jamison, FNP
-
Lindsay Jobe, M.D.
-
Damon Kalcich, D.O.
-
Edward Kompare, M.D.
-
Ranjit Kumar, M.D
-
Erica Lankenau, PA
-
Ronald Alan Tung Li, M.D.
-
Maureen Mannas, MD
-
Melissa Marquez Conklin, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040218000865 | NM | Part B Supplier - Clinic/Group Practice | 4587559505 |
Receives reassigned benefits from 396 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Farmington, NM; Bloomfield, NM; Aztec, NM |
National Provider Directory
Locations
735 W Animas St
Farmington, NM 87401
Phone (505) 564-6850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
735 W Animas St
Farmington, NM 87401-5616
Mailing address
PO Box 844088
Dallas, TX 75284-4088
Phone (505) 609-2258
Other names
- SJR GENERAL SURGEONS
Other providers in Farmington, NM
- 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
- San Juan Regional Medical Center Inc
All providers in Farmington, NM · Surgery 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 Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.