Provider Demographics
NPI:1679641963
Name:SOUTHWEST WOMEN'S SONOGRAPHY, LLC
Entity Type:Organization
Organization Name:SOUTHWEST WOMEN'S SONOGRAPHY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:REUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-884-9687
Mailing Address - Street 1:PO BOX 2160
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2160
Mailing Address - Country:US
Mailing Address - Phone:505-884-9687
Mailing Address - Fax:505-884-9688
Practice Address - Street 1:4600 MONTGOMERY BLVD NE
Practice Address - Street 2:BUILDING A, SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1210
Practice Address - Country:US
Practice Address - Phone:505-884-9687
Practice Address - Fax:505-884-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0502207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201045136OtherPREBYTERIAN HEALTH PLAN
NM53157532Medicaid
NMP 12036477OtherMULTIPLAN
NM00NM009L79OtherBLUE CROSS BLUE SHIELD
NM53157532Medicaid
NM=========OtherLOVELACE HEALTH PLAN
NM========= 87109 A001OtherTRI CARE
NMP 12036477OtherMULTIPLAN
NM53157532Medicaid