Basic Information
| Provider Information | |||||||||
| NPI: | 1013937408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA FE IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059839350 | ||||||||
| FaxNumber: | 5059558763 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059839350 | ||||||||
| FaxNumber: | 5059558763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEHMAN | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5059839350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 76347 | 05 | NM | MEDICAID |