Healthcare Provider Details

I. General information

NPI: 1871538694
Provider Name (Legal Business Name): SOUTHWEST ENDOSCOPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7788 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4342
US

IV. Provider business mailing address

7788 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4342
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-1600
  • Fax: 505-999-1650
Mailing address:
  • Phone: 505-999-1600
  • Fax: 505-999-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number6712
License Number StateNM

VIII. Authorized Official

Name: PATRICIA LORANE CARRASCO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 505-999-1610