Provider Demographics
NPI:1861420465
Name:SANTA FE ANESTHESIA SPECIALISTS, P.C.
Entity type:Organization
Organization Name:SANTA FE ANESTHESIA SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MULLICAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-983-3275
Mailing Address - Street 1:PO BOX 14423
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-4423
Mailing Address - Country:US
Mailing Address - Phone:505-323-7200
Mailing Address - Fax:505-323-7206
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-983-3275
Practice Address - Fax:505-983-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0603128207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43555012Medicaid