Healthcare Provider Details

I. General information

NPI: 1225065527
Provider Name (Legal Business Name): SOUTHWESTERN REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N 13TH ST
ARTESIA NM
88210-1167
US

IV. Provider business mailing address

PO BOX 629
ARTESIA NM
88211-0629
US

V. Phone/Fax

Practice location:
  • Phone: 505-748-8356
  • Fax: 505-748-8305
Mailing address:
  • Phone: 505-748-8356
  • Fax: 505-748-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: KENNETH W RANDALL
Title or Position: CEO
Credential:
Phone: 505-748-3333