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General NPI Number Information
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NPI Number | 1295918324
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FAMILY MEDICAL CARE, INC.
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 200 COURT ST.
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City | CLAYTON
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State | NM
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Zip | 88415
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Country | US
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Telephone | 575-374-2020
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Fax | 575-374-2040
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Provider Business Mailing Address
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Address Line | PO BOX 157
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City | CLAYTON
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State | NM
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Zip | 88415-0157
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Country | US
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Telephone | 575-374-2020
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Fax | 575-374-2040
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JESSIE JEAN FLUHMAN
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Credential | FNP
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Telephone | 575-374-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2958205
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License Number State | NM
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