NPIMap

Organization Active NPI

Santa Teresa Medical Care Center PC

  • Family Medicine Physician
  • Santa Teresa, NM
National Provider Identifier
1669459947
Registry record updated Jul 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANTA TERESA MEDICAL CARE CENTER PC
Practice address
5055 McNutt Rd
Santa Teresa, NM 88008-9442
Phone
(575) 589-5005
Fax
(575) 589-1333
NPI assigned
Dec 28, 2005
Last updated
Jul 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Laurence Juarez
Title
Administrator
Phone
(915) 842-0504

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

5055 McNutt Rd
Santa Teresa, NM 88008-9442

Mailing address

5055 McNutt Rd
PO Box 5
Santa Teresa, NM 88008-9442
Phone (575) 589-5005

Other identifiers 3

IdentifierTypeStateIssuer
0733024-01MedicaidTX
49189MedicaidNM
CS9566OtherNMPALMETTO GBA

Other names 1

  • Santa Teresa Medical Care Center Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1669459947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5055 MCNUTT RD",
            "address_2": "PO BOX 5",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089442",
            "telephone_number": "575-589-5005",
            "fax_number": "575-589-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5055 MCNUTT RD",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089442",
            "telephone_number": "575-589-5005",
            "fax_number": "575-589-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA TERESA MEDICAL CARE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "JUAREZ",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "915-842-0504",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0733024-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49189",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "CS9566",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Teresa Medical Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Teresa, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.