Provider Demographics
NPI:1851348148
Name:SOUTHWEST AMBULANCE OF NEW MEXICO
Entity Type:Organization
Organization Name:SOUTHWEST AMBULANCE OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-655-7202
Mailing Address - Street 1:PO BOX 26896
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6896
Mailing Address - Country:US
Mailing Address - Phone:480-627-6143
Mailing Address - Fax:480-627-6243
Practice Address - Street 1:108 WEST DENNING
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203
Practice Address - Country:US
Practice Address - Phone:480-627-6420
Practice Address - Fax:480-627-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00RC35OtherBCBS PIN
NM03430251Medicaid
NM03430251Medicaid
NM03430251Medicaid
NMNM00RC35OtherBCBS PIN