Provider Demographics
NPI:1366868010
Name:SOUTHWEST TEAM CORP
Entity Type:Organization
Organization Name:SOUTHWEST TEAM CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRES
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSBA
Authorized Official - Phone:786-970-0573
Mailing Address - Street 1:10300 SW 72ND AVE
Mailing Address - Street 2:SUITE 470B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3107
Mailing Address - Country:US
Mailing Address - Phone:786-970-0573
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND AVE
Practice Address - Street 2:SUITE 470B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3107
Practice Address - Country:US
Practice Address - Phone:786-970-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSWTEAM970OtherOBAMACARE INSURANCES