Healthcare Provider Details

I. General information

NPI: 1508035395
Provider Name (Legal Business Name): SOUTHWEST THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PRINCETON DR NE STE S24
ALBUQUERQUE NM
87107-2049
US

IV. Provider business mailing address

PO BOX 7100
ALBUQUERQUE NM
87194-7100
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-6330
  • Fax: 505-872-9148
Mailing address:
  • Phone: 505-888-6330
  • Fax: 505-872-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN CHAVEZ
Title or Position: CFO
Credential:
Phone: 505-888-6330