Provider Demographics
NPI: | 1043680440 |
---|---|
Name: | SOUTHWEST MEDICAL ASSOCIATES, INC |
Entity Type: | Organization |
Organization Name: | SOUTHWEST MEDICAL ASSOCIATES, INC |
Other - Org Name: | SOUTHWEST MEDICAL ASSOCIATES - TENAYA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEDICAL STAFF MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EMILY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CASTILLO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 702-480-2550 |
Mailing Address - Street 1: | PO BOX 35380 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89133-5380 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-579-3203 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2650 N TENAYA WAY |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89128-1102 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-877-8660 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-09-29 |
Last Update Date: | 2024-01-09 |
Deactivation Date: | 2019-03-04 |
Deactivation Code: | |
Reactivation Date: | 2019-03-27 |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |