=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376673939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST PODIATRY CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 09/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1903 WYOMING BLVD NE SUITE C
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-298-7666
-----------------------------------------------------
Fax | 505-296-0464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1903 WYOMING BLVD NE SUITE C
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-298-7666
-----------------------------------------------------
Fax | 505-296-0464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FAITH CARIN SHAPIRO
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 505-298-7666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 175
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------