Healthcare Provider Details

I. General information

NPI: 1952774796
Provider Name (Legal Business Name): SOUTHWEST CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W ALAMEDA ST SUITE 25
SANTA FE NM
87501-1681
US

IV. Provider business mailing address

649 HARKLE RD SUITE E
SANTA FE NM
87505-4765
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8869
  • Fax: 505-982-7321
Mailing address:
  • Phone: 505-989-8200
  • Fax: 505-989-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1300029059
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ADAMS
Title or Position: CEO
Credential:
Phone: 505-989-8200