Provider Demographics
NPI:1649572454
Name:SOUTHWESTERN PRIVATE SERVICES D/B/A SOUTHWESTERN TRANSPORTATION
Entity Type:Organization
Organization Name:SOUTHWESTERN PRIVATE SERVICES D/B/A SOUTHWESTERN TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-326-6024
Mailing Address - Street 1:2232 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8801
Mailing Address - Country:US
Mailing Address - Phone:505-326-6024
Mailing Address - Fax:505-327-2052
Practice Address - Street 1:408 N AUBURN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5816
Practice Address - Country:US
Practice Address - Phone:505-326-6024
Practice Address - Fax:505-327-2052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN PRIVATE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55642343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)