Provider Demographics
NPI:1386083889
Name:SOUTHWEST BONE AND JOINT INSTITUTE PC
Entity type:Organization
Organization Name:SOUTHWEST BONE AND JOINT INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-534-1919
Mailing Address - Street 1:1268 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7229
Mailing Address - Country:US
Mailing Address - Phone:575-534-1919
Mailing Address - Fax:575-534-0135
Practice Address - Street 1:721 E HOLLY ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5245
Practice Address - Country:US
Practice Address - Phone:575-546-3604
Practice Address - Fax:575-546-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM98-375207X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB4014Medicaid
NM700521010Medicare PIN