Healthcare Provider Details

I. General information

NPI: 1841302379
Provider Name (Legal Business Name): SOUTHWEST BONE AND JOINT INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 E 32ND ST
SILVER CITY NM
88061-7229
US

IV. Provider business mailing address

1268 E 32ND ST
SILVER CITY NM
88061-7229
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-1919
  • Fax: 575-534-0135
Mailing address:
  • Phone: 575-534-1919
  • Fax: 575-534-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNM98-375
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNM
# 8
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberNM98-375
License Number StateNM

VIII. Authorized Official

Name: MR. MICHAEL MCMILLAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-534-1919