NPIMap

San Juan Regional Medical Center Inc

Organization Active NPI Family Medicine Physician · Bloomfield, NM

NPI 1508219916 · NPPES record last updated Jul 20, 2016

Key facts

NPI
1508219916
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
SAN JUAN REGIONAL MEDICAL CENTER INC
Practice address
100 N Church St Ste C
Bloomfield, NM 87413-5754
Phone
(505) 609-6675
Fax
(505) 609-6579
NPI assigned
Jul 20, 2016
Organization subpart
No

Authorized official

Name
Karen S Miller
Title
Cfo
Phone
(505) 609-6114

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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

Tax ID family
San Juan Region Med Ctr Inc (13 organizations share this tax ID)

Locations

100 N Church St
Ste C
Bloomfield, NM 87413
Phone (505) 333-7429

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

100 N Church St Ste C
Bloomfield, NM 87413-5754

Mailing address

PO Box 6210
Farmington, NM 87499-6210
Phone (505) 609-2258

Other names

  • SAN JUAN HEALTH PARTNERS WALK-IN CLINIC Doing business as

Other providers in Bloomfield, NM

All providers in Bloomfield, NM · Family Medicine Physician in New Mexico

Sources for this page

Verify at the official NPI Registry.