MEDICARE: SOUTHWEST FAMILY MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		NM
2	207Q00000X	Family Medicine Physician	A-1194-02	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053316208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FAMILY MEDICINE, PC

Provider Business Mailing Address
First Line	:	1318 E 32ND ST
Second Line	:	FL 1
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7252
Country	:	US
Telephone Number	:	505-388-5170
Fax Number	:	505-388-5176

Provider Business Practice Location Address
First Line	:	1318 E 32ND ST
Second Line	:	FL 1
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7252
Country	:	US
Telephone Number	:	505-388-5170
Fax Number	:	505-388-5176

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN M STANLEY
Credential	:	M.D.
Telephone Number	:	505-388-5170

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	05/12/2008

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