Provider Demographics
NPI:1144893249
Name:SAN JUAN ONCOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:SAN JUAN ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:THURSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-564-6871
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-1799
Mailing Address - Country:US
Mailing Address - Phone:505-564-6850
Mailing Address - Fax:505-258-4959
Practice Address - Street 1:1305 ESCALANTE DR STE 102-103
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8931
Practice Address - Country:US
Practice Address - Phone:970-335-9261
Practice Address - Fax:970-828-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46926534Medicaid
NM97388866Medicaid
NM38022222Medicaid
NM90124758Medicaid