Healthcare Provider Details

I. General information

NPI: 1912233420
Provider Name (Legal Business Name): SOUTHWEST TRAUMA SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204A W MARKET ST
SILVER CITY NM
88061-5370
US

IV. Provider business mailing address

204A W MARKET ST
SILVER CITY NM
88061-5370
US

V. Phone/Fax

Practice location:
  • Phone: 575-654-0812
  • Fax:
Mailing address:
  • Phone: 575-654-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06657
License Number StateNM

VIII. Authorized Official

Name: MR. PAUL ERIC GALBRAITH
Title or Position: SOLE MGR
Credential: LISW, LCSW
Phone: 575-654-0812