Provider Demographics
NPI:1033167598
Name:SOUTHWEST PET INSTITUTE, LLC
Entity Type:Organization
Organization Name:SOUTHWEST PET INSTITUTE, LLC
Other - Org Name:SOUTHWEST PET INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-912-1878
Mailing Address - Street 1:1951 W 25TH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6925
Mailing Address - Country:US
Mailing Address - Phone:928-314-4800
Mailing Address - Fax:928-314-4833
Practice Address - Street 1:1951 W 25TH ST
Practice Address - Street 2:SUITE G
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6925
Practice Address - Country:US
Practice Address - Phone:928-314-4800
Practice Address - Fax:928-314-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4028261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ991712Medicaid
AZ0886210OtherBCBSAZ
AZ991712Medicaid