Healthcare Provider Details

I. General information

NPI: 1306797386
Provider Name (Legal Business Name): SOUTH WEST MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 MCNUTT RD STE D
SANTA TERESA NM
88008-8001
US

IV. Provider business mailing address

5805 MCNUTT RD STE D
SANTA TERESA NM
88008-8001
US

V. Phone/Fax

Practice location:
  • Phone: 575-332-4007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL BUSTILLOS
Title or Position: DOO
Credential:
Phone: 575-332-4007