Organization
SAN JUAN ENDOSCOPY LLC
Active
Organization
SAN JUAN ENDOSCOPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE PAYNE MD (DIRECTOR)
(505) 564-8200
Entity
Organization
Contact information
Practice address
950 W PINON ST, FARMINGTON, NM 87401-5905
(803) 252-7979
Mailing address
PO BOX 1974, FARMINGTON, NM 87499-1974
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76287769
—
NM
Enumeration date
10/02/2006
Last updated
11/14/2007
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