| Doctors Of Santa Teresa Pc | |
|
5290 Mcnutt Road Santa Teresa NM 88008-9648 | |
| (575) 589-1144 | |
| (575) 589-2008 |
| Full Name | Doctors Of Santa Teresa Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 5290 Mcnutt Road, Santa Teresa, New Mexico |
| Authorized Official Name and Position | Jennifer Larsen (ADMINISTRATOR) |
| Authorized Official Contact | 5755891144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctors Of Santa Teresa Pc Po Box 1590 Santa Teresa NM 88008-9648 Ph: (575) 589-1144 | Doctors Of Santa Teresa Pc 5290 Mcnutt Road Santa Teresa NM 88008-9648 Ph: (575) 589-1144 |
| NPI Number | 1639121692 |
|---|---|
| Provider Enumeration Date | 05/17/2006 |
| Last Update Date | 01/23/2017 |
| Medicare PECOS PAC ID | 6305740002 |
|---|---|
| Medicare Enrollment ID | O20031124000676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639121692 | NPI | - | NPPES |
| 7908 | Other | NM | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | CL00010400 (New Mexico) | Primary |
| Provider Name | Emilio T. Rivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366410276 PECOS PAC ID: 1951205665 Enrollment ID: I20031124000725 |
| Provider Name | Maria T Becerra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568427466 PECOS PAC ID: 0446231302 Enrollment ID: I20150106001156 |
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