Healthcare Provider Details

I. General information

NPI: 1003202201
Provider Name (Legal Business Name): SOUTHWEST DME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BUTLER AVE SUITE 105
FARMINGTON NM
87401-6866
US

IV. Provider business mailing address

3401 N BUTLER AVE SUITE 105
FARMINGTON NM
87401-6866
US

V. Phone/Fax

Practice location:
  • Phone: 505-947-5010
  • Fax:
Mailing address:
  • Phone: 505-947-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPT2010-0068
License Number StateNM

VIII. Authorized Official

Name: MR. DAVID CAMERON PADGETT
Title or Position: OWNER
Credential: RPSGT
Phone: 505-716-4180