Healthcare Provider Details

I. General information

NPI: 1720505571
Provider Name (Legal Business Name): SOUTHWEST EMERGENCY MEDICAL ASSOCIATES OF NM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S. TELSHOR BLVD
LAS CRUCES NM
88011-5076
US

IV. Provider business mailing address

5000 HOPYARD RD STE 100
PLEASANTON CA
94588-3146
US

V. Phone/Fax

Practice location:
  • Phone: 954-924-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE CRESPO
Title or Position: PRESIDENT
Credential: MD
Phone: 865-693-1000