Provider Demographics
NPI:1073844049
Name:SOUTHWEST CENTER FOR PAIN MANAGEMENT
Entity Type:Organization
Organization Name:SOUTHWEST CENTER FOR PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:847-530-0236
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-0984
Mailing Address - Country:US
Mailing Address - Phone:847-530-0236
Mailing Address - Fax:
Practice Address - Street 1:40 FIRST PLAZA CTR NW
Practice Address - Street 2:STE # 62
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3355
Practice Address - Country:US
Practice Address - Phone:847-530-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0016172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1285773614OtherNPI TYPE 1