Provider Demographics
NPI:1194928382
Name:SOUTHWEST HEALTH CARE PROFESSIONALS INC
Entity type:Organization
Organization Name:SOUTHWEST HEALTH CARE PROFESSIONALS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICEMARIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SLAVEN-EMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN,FNP-C
Authorized Official - Phone:505-325-6938
Mailing Address - Street 1:1601 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4307
Mailing Address - Country:US
Mailing Address - Phone:505-564-3628
Mailing Address - Fax:505-325-9228
Practice Address - Street 1:1601 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4307
Practice Address - Country:US
Practice Address - Phone:505-564-3628
Practice Address - Fax:505-325-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2012-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM300521110Medicare PIN