Healthcare Provider Details

I. General information

NPI: 1154742765
Provider Name (Legal Business Name): SOUTHWEST CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST STE E
SANTA FE NM
87505-4781
US

IV. Provider business mailing address

649 HARKLE RD
SANTA FE NM
87505-4765
US

V. Phone/Fax

Practice location:
  • Phone: 505-954-1921
  • Fax:
Mailing address:
  • Phone: 505-989-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. JEFF THOMAS
Title or Position: CEO
Credential:
Phone: 505-216-0333