Provider Demographics
NPI:1598813115
Name:SOUTHWEST PROFESSIONAL MEDICAL ARTS
Entity Type:Organization
Organization Name:SOUTHWEST PROFESSIONAL MEDICAL ARTS
Other - Org Name:MICB RADIOOGY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-395-0155
Mailing Address - Street 1:4000 EMPIRE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0400
Mailing Address - Country:US
Mailing Address - Phone:661-395-0155
Mailing Address - Fax:661-395-0102
Practice Address - Street 1:4000 EMPIRE DR
Practice Address - Street 2:STE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0400
Practice Address - Country:US
Practice Address - Phone:661-395-0155
Practice Address - Fax:661-395-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty