Provider Demographics
NPI:1376502591
Name:SOUTHWEST RESPIRATORY LLC
Entity Type:Organization
Organization Name:SOUTHWEST RESPIRATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:SR
Authorized Official - Credentials:RCP
Authorized Official - Phone:505-888-6200
Mailing Address - Street 1:PO BOX 30186
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-0186
Mailing Address - Country:US
Mailing Address - Phone:505-888-6200
Mailing Address - Fax:505-888-6202
Practice Address - Street 1:5109 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3045
Practice Address - Country:US
Practice Address - Phone:505-888-6200
Practice Address - Fax:505-888-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000B6822Medicaid
NM5104010002Medicare NSC