Provider Demographics
NPI:1093487449
Name:NES SOUTHWEST MEDICAL SERVICES INC
Entity type:Organization
Organization Name:NES SOUTHWEST MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-557-6183
Mailing Address - Street 1:7300 STATE HIGHWAY 121 STE 370-374
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1987
Mailing Address - Country:US
Mailing Address - Phone:469-557-6183
Mailing Address - Fax:469-640-6671
Practice Address - Street 1:8960 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-7323
Practice Address - Country:US
Practice Address - Phone:806-351-6987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093487449Medicaid