MEDICARE: SOUTHWEST IMMUNODIAGNOSTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1962479048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST IMMUNODIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	8122 DATAPOINT DR
Second Line	:	SUITE 912
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3272
Country	:	US
Telephone Number	:	210-614-3703
Fax Number	:	210-615-8186

Provider Business Practice Location Address
First Line	:	8122 DATAPOINT DR
Second Line	:	SUITE 912
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3272
Country	:	US
Telephone Number	:	210-614-3703
Fax Number	:	210-615-8186

Authorized Official
Title or Position	:	CFO
Name	:	LYNDA ATWOOD
Credential	:
Telephone Number	:	210-614-3703

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	08/22/2020

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