Provider Demographics
NPI:1114924024
Name:SOUTHWEST NEUROSURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHWEST NEUROSURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STONEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-244-0080
Mailing Address - Street 1:8080 ACADEMY RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1159
Mailing Address - Country:US
Mailing Address - Phone:505-244-0080
Mailing Address - Fax:505-244-9048
Practice Address - Street 1:8080 ACADEMY RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1159
Practice Address - Country:US
Practice Address - Phone:505-244-0080
Practice Address - Fax:505-244-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001257207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83483861Medicaid
NMNM029548OtherBCBS OF NM
NM83483861Medicaid