Healthcare Provider Details

I. General information

NPI: 1386083889
Provider Name (Legal Business Name): SOUTHWEST BONE AND JOINT INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E HOLLY ST
DEMING NM
88030-5245
US

IV. Provider business mailing address

1268 E 32ND ST
SILVER CITY NM
88061-7229
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-3604
  • Fax: 575-546-3873
Mailing address:
  • Phone: 575-534-1919
  • Fax: 575-534-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberNM98-375
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNM98-375
License Number StateNM

VIII. Authorized Official

Name: MICHAEL MCMILLAN
Title or Position: ADMINSTRATOR
Credential:
Phone: 575-534-1919