Provider Demographics
NPI:1679663447
Name:SOUTHWEST MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL ASSOCIATES, INC
Other - Org Name:SOUTHWEST MEDICAL RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-2550
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-560-2874
Mailing Address - Fax:702-560-2928
Practice Address - Street 1:888 S RANCHO DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-877-8600
Practice Address - Fax:702-560-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-07-25
Deactivation Date:2019-03-04
Deactivation Code:
Reactivation Date:2019-03-27
Provider Licenses
StateLicense IDTaxonomies
NV317972085R0202X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002702006Medicaid
NVP00112269OtherRR MEDICARE
NV31797Medicare ID - Type UnspecifiedNORIDIAN ADMIN SVCS
NVV31797Medicare PIN