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General NPI Number Information
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NPI Number | 1821299462
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Entity Type | Organization
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Legal Business Name | SOUTHWEST INTERNAL MEDICINE GROUP
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 09/02/2023
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Provider Practice Location Address
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Address Line | 15255 N 40TH ST SUITE 127
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City | PHOENIX
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State | AZ
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Zip | 85032-4624
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Country | US
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Telephone | 602-253-0855
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Fax | 602-424-6986
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Provider Business Mailing Address
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Address Line | 15255 N 40TH ST SUITE 127
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City | PHOENIX
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State | AZ
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Zip | 85032-4624
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Country | US
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Telephone | 602-253-0855
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Fax | 602-424-6986
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | EMILY CASTILLO
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Credential |
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Telephone | 702-480-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 14478
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License Number State | AZ
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