Provider Demographics
NPI:1053316208
Name:SOUTHWEST FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:SOUTHWEST FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-388-5170
Mailing Address - Street 1:1318 E 32ND ST
Mailing Address - Street 2:FL 1
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7252
Mailing Address - Country:US
Mailing Address - Phone:505-388-5170
Mailing Address - Fax:505-388-5176
Practice Address - Street 1:1318 E 32ND ST
Practice Address - Street 2:FL 1
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7252
Practice Address - Country:US
Practice Address - Phone:505-388-5170
Practice Address - Fax:505-388-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1194-02207Q00000X
NM332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF7238Medicaid
NMC22178Medicare UPIN
NM850416548Medicare PIN
NM1007630001Medicare NSC
NMR10765Medicare UPIN