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General NPI Number Information
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NPI Number | 1194928382
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Entity Type | Organization
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Legal Business Name | SOUTHWEST HEALTH CARE PROFESSIONALS INC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/25/2012
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Provider Practice Location Address
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Address Line | 1601 E 20TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-4307
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Country | US
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Telephone | 505-564-3628
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Fax | 505-325-9228
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Provider Business Mailing Address
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Address Line | 1601 E 20TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-4307
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Country | US
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Telephone | 505-564-3628
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Fax | 505-325-9228
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Authorized Official
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Title or Position | CEO
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Name | ALICEMARIE F. SLAVEN-EMOND
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Credential | RN,MSN,FNP-C
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Telephone | 505-325-6938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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