Provider Demographics
NPI:1104993369
Name:SOUTHWEST SLEEP INC
Entity type:Organization
Organization Name:SOUTHWEST SLEEP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, MBA
Authorized Official - Phone:505-716-4180
Mailing Address - Street 1:3401 N BUTLER AVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6866
Mailing Address - Country:US
Mailing Address - Phone:505-716-4180
Mailing Address - Fax:505-325-1365
Practice Address - Street 1:3401 NORTH BUTLER AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-716-4180
Practice Address - Fax:505-325-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM174400000X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty