Healthcare Provider Details

I. General information

NPI: 1649572454
Provider Name (Legal Business Name): SOUTHWESTERN PRIVATE SERVICES D/B/A SOUTHWESTERN TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N AUBURN AVE
FARMINGTON NM
87401-5816
US

IV. Provider business mailing address

2232 NW 164TH ST
EDMOND OK
73013-8801
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-6024
  • Fax: 505-327-2052
Mailing address:
  • Phone: 505-326-6024
  • Fax: 505-327-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number55642
License Number StateNM

VIII. Authorized Official

Name: IVY SNIDER
Title or Position: PRESIDENT
Credential:
Phone: 505-326-6024