Provider Demographics
NPI:1376673939
Name:SOUTHWEST PODIATRY CENTER PC
Entity Type:Organization
Organization Name:SOUTHWEST PODIATRY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:CARIN
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-298-7666
Mailing Address - Street 1:1903 WYOMING BLVD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2821
Mailing Address - Country:US
Mailing Address - Phone:505-298-7666
Mailing Address - Fax:505-296-0464
Practice Address - Street 1:1903 WYOMING BLVD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2821
Practice Address - Country:US
Practice Address - Phone:505-298-7666
Practice Address - Fax:505-296-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM175213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54577Medicaid
NMNMB2062Medicare PIN
NM0746300001Medicare NSC
NMT41098Medicare UPIN