Healthcare Provider Details

I. General information

NPI: 1609336460
Provider Name (Legal Business Name): SOUTHWEST CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W ALAMEDA ST
SANTA FE NM
87501-1681
US

IV. Provider business mailing address

4710 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-2156
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-4044
  • Fax:
Mailing address:
  • Phone: 505-780-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY THOMAS
Title or Position: CEO
Credential:
Phone: 505-216-0333