Basic Information
| Provider Information | |||||||||
| NPI: | 1861420465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA FE ANESTHESIA SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14423 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871914423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053237200 | ||||||||
| FaxNumber: | 5053237206 | ||||||||
| Practice Location | |||||||||
| Address1: | 1631 HOSPITAL DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059833275 | ||||||||
| FaxNumber: | 5059834812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MULLICAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5059833275 | ||||||||
| 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 | 207L00000X | 0603128 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 43555012 | 05 | NM | MEDICAID |