SAN JUAN REGIONAL MEDICAL CENTER INC (NPI# 1104142215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104142215 |
| Entity Type | Organization |
| Organization Name | SAN JUAN REGIONAL MEDICAL CENTER INC |
| Other Organization Name | SJR GENERAL SURGEONS |
| Practice Address |
630 W Maple St Farmington NM 87401-6113 |
| Mailing Address |
Po Box 6210 Farmington NM 87499-6210 |
| Practice Telephone | 5056096300 |
| Practice Fax Number | 5056096749 |
| Mailing Telephone | 5056092258 |
| Mailing Fax Number | 5056092259 |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2010-12-02 |
| Authorized Official Name | J MICHAEL PHILIPS (CSO) |
| Authorized Official Telephone | 5056096025 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SJR GENERAL SURGEONS | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902463508 | San Juan Regional Medical Center Inc | Urology | 1485 Florida Rd Ste 103a, Durango, CO 81301-6873 | 2019-05-20 |
| 1174820153 | San Juan Regional Medical Center Inc | Emergency Medicine | 4251 English Rd, Farmington, NM 87402-1116 | 2011-02-28 |
| 1811915234 | San Juan Regional Medical Center Inc | Physical Medicine & Rehabilitation | 525 S Schwartz Ave, Farmington, NM 87401-5955 | 2006-07-17 |
| 1225076003 | San Juan Regional Medical Center Inc | Internal Medicine | 407 S. Schwartz Ave, Suite 201, Farmington, NM 87401-5973 | 2006-06-03 |
| 1861467433 | San Juan Regional Medical Center Inc | Internal Medicine | 120 Llano St, Aztec, NM 87410 | 2006-02-17 |
| 1326663592 | San Juan Regional Medical Center Inc | Rehabilitation Unit | 525 S Schwartz Ave, Farmington, NM 87401-5955 | 2020-06-12 |
| 1639662901 | San Juan Regional Medical Center Inc | Internal Medicine | 940 W Pinon St, Farmington, NM 87401-5905 | 2018-06-12 |
| 1508219916 | San Juan Regional Medical Center Inc | Family Medicine | 100 N Church St Ste C, Bloomfield, NM 87413-5754 | 2016-07-20 |
| 1003296534 | San Juan Regional Medical Center Inc | Urology | 2700 Farmington Ave, Building E, Suite 1, Farmington, NM 87401-4559 | 2015-05-29 |
| 1023379609 | San Juan Regional Medical Center Inc | Specialist/Technologist, Other | 801 W Maple St, Farmington, NM 87401-5630 | 2012-05-31 |
| Street Address |
630 W MAPLE ST |
| City | FARMINGTON |
| State | NM |
| Zip Code | 87401-6113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619950326 | Markus E Garard | Orthopaedic Surgery | 630 W Maple St, Farmington, NM 87401-6113 | 2005-11-28 |
| 1679042410 | Theresa Rae Gent | Physician Assistant | 630 W Maple St, Farmington, NM 87401-6113 | 2018-11-23 |
| 1669820544 | Alison Yasuyo Krueger | Physician Assistant | 630 W Maple St, Farmington, NM 87401-6113 | 2016-06-01 |
| 1891150108 | Erica Lankenau | Physician Assistant | 630 W Maple St, Farmington, NM 87401-6113 | 2015-12-31 |
| 1780024174 | Philip Keith Ernest | Surgery | 630 W Maple St, Farmington, NM 87401 | 2013-06-28 |
| 1245485994 | Dwayne L Gibbs Md PC | Surgery | 630 W Maple St, Suite A, Farmington, NM 87401-6113 | 2008-11-21 |
| 1770734576 | James M Boyd | Surgery | 630 W Maple St, Farmington, NM 87401-6113 | 2008-10-10 |
| 1558571851 | Damon Kalcich | Surgery | 630 W Maple St, Farmington, NM 87401-6113 | 2007-05-23 |
| 1316073141 | Dwayne L Gibbs | Surgery | 630 W Maple St, Farmington, NM 87401-6113 | 2007-02-26 |
| 1508992355 | Melania Yeats | Surgery | 630 W Maple St, Farmington, NM 87401-6113 | 2007-02-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164035192 | Jaylene Miller | Behavior Technician | 912 Fairgrounds Rd. Trl 36, Farmington, NM 87401 | 2020-08-28 |
| 1255940326 | John Andrew Martinez | Behavioral Analyst | 211 N Auburn, Farmington, NM 87401 | 2020-07-24 |
| 1598304990 | Chasitity Beulah Nez | Behavior Technician | 37 Rd 7101 #127, Farmington, NM 87401 | 2020-01-02 |
| 1205478575 | Micah Magee | Speech-Language Pathologist | Farmington High School, 2200 N. Sunset Ave, Farmington, NM 87401 | 2019-10-08 |
| 1831659754 | Lelilah Todacheene | Social Worker | 1204 Camina Real, Farmington, NM 87401 | 2019-03-25 |
| 1306323555 | Litany of Life | Counselor | 1010 Ridgeway Place, Farmington, NM 87401 | 2018-07-20 |
| 1093291213 | Brittany Bigham | Nurse Practitioner | 1001 W Broadway Ste E, Farmington, NM 87401 | 2018-07-11 |
| 1528556305 | Hairoun Home Health | Home Health | 1200 East 20th Street, Farmington, NM 87401 | 2018-04-26 |
| 1003338732 | Silver Tongue Speech & Voice, LLC | Clinic/Center | 3001 Northridge Dr Ste C, Farmington, NM 87401 | 2017-07-14 |
| 1902256621 | Capacity Builders Inc | Taxi | 418 W Broadway, Farmington, NM 87401 | 2016-06-14 |
| Find all providers in zip 87401 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235398611 | Robert Angelo Brenes | Surgery | 76 Batterson Park Rd Ste 106, Farmington, CT 06032-2571 | 2008-06-02 |
| 1245341635 | David Alan Dunworth | Surgery | 802 E Navajo St, Farmington, NM 87401-9119 | 2006-08-31 |
| 1083651269 | H Jack Myers | Surgery | 395 Chestnut Hill Rd, Farmington, NH 03835-3919 | 2006-05-31 |
| 1548256498 | Lori L Wilson | Surgery | 263 Farmington Ave, Mc 1614, Neag Comprehensive Cancer Center - Surg Onc, Farmington, CT 06030-0001 | 2005-09-26 |
| 1639669591 | Brad R Kincaid | Surgery | 263 Farmington Ave, Farmington, CT 06030-1782 | 2018-05-16 |
| 1871925610 | Fadi Fahad | Surgery | 263 Farmington Ave, Farmington, CT 06030-3412 | 2013-08-03 |
| 1780024174 | Philip Keith Ernest | Surgery | 630 W Maple St, Farmington, NM 87401 | 2013-06-28 |
| 1730522897 | Katerina Dukleska | Surgery | 263 Farmington Ave, Farmington, CT 06030-8072 | 2013-04-09 |
| 1730447251 | Stacey Lynn Gutman | Surgery | 181 Franklin Health Commons, Farmington, ME 04938 | 2012-05-03 |
| 1205112661 | Paul Richard Cutler | Surgery | 801 West Maple, San Juan Regional Medical Center, Farmington, NM 87401 | 2011-10-31 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 87401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.