MEDICARE: SOUTHWEST PHYSICIANS GROUP LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1982025797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PHYSICIANS GROUP LLC

Provider Business Mailing Address
First Line	:	3950 S EASTERN AVE
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5174
Country	:	US
Telephone Number	:	702-629-3146
Fax Number	:	702-527-5966

Provider Business Practice Location Address
First Line	:	3950 S EASTERN AVE
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5174
Country	:	US
Telephone Number	:	702-629-3146
Fax Number	:	702-527-5966

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH E DI PALMA
Credential	:	M.D.
Telephone Number	:	702-629-3146

Provider Enumeration Date	:	12/20/2013
Last Update Date	:	04/04/2014

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