Healthcare Provider Details

I. General information

NPI: 1053316208
Provider Name (Legal Business Name): SOUTHWEST FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 E 32ND ST FL 1
SILVER CITY NM
88061-7252
US

IV. Provider business mailing address

1318 E 32ND ST FL 1
SILVER CITY NM
88061-7252
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-5170
  • Fax: 505-388-5176
Mailing address:
  • Phone: 505-388-5170
  • Fax: 505-388-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-1194-02
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. JOHN M STANLEY
Title or Position: OWNER
Credential: M.D.
Phone: 505-388-5170