Provider Demographics
NPI:1083008817
Name:SOUTHWEST NEPHROLOGY
Entity Type:Organization
Organization Name:SOUTHWEST NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-855-8519
Mailing Address - Street 1:9440 VISCOUNT BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7049
Mailing Address - Country:US
Mailing Address - Phone:915-855-8519
Mailing Address - Fax:915-849-8238
Practice Address - Street 1:9440 VISCOUNT BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7049
Practice Address - Country:US
Practice Address - Phone:915-855-8519
Practice Address - Fax:915-849-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2726207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201456503Medicaid
TXTXB100704Medicare PIN