Provider Demographics
NPI:1760681514
Name:SOUTHWEST CHILD AND FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:SOUTHWEST CHILD AND FAMILY MEDICINE, P.A.
Other - Org Name:SWCFM. P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-224-1122
Mailing Address - Street 1:3450 W WHEATLAND RD
Mailing Address - Street 2:POB II SUITE 440
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3470
Mailing Address - Country:US
Mailing Address - Phone:972-224-1122
Mailing Address - Fax:972-224-8084
Practice Address - Street 1:3450 W WHEATLAND RD
Practice Address - Street 2:POB II SUITE 440
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3470
Practice Address - Country:US
Practice Address - Phone:972-224-1122
Practice Address - Fax:972-224-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8121207Q00000X
TXL3646208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160778001Medicaid
TXL3646OtherTEXAS STATE BOARD LICENSE
TX00272VMedicare PIN