Provider Demographics
NPI:1891903753
Name:SOUTHWEST INTERVENTIONAL PAIN SPECIALISTS, PC
Entity Type:Organization
Organization Name:SOUTHWEST INTERVENTIONAL PAIN SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:50 OWNER AND PRESIDENT, SOUTHWEST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-881-5080
Mailing Address - Street 1:4700 JEFFERSON NE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2132
Mailing Address - Country:US
Mailing Address - Phone:505-881-5080
Mailing Address - Fax:505-872-2306
Practice Address - Street 1:4700 JEFFERSON NE
Practice Address - Street 2:SUITE 700
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2132
Practice Address - Country:US
Practice Address - Phone:505-881-5080
Practice Address - Fax:505-872-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208VP0014X
NM90-100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21889023Medicaid
NM21889023Medicaid
E71491Medicare UPIN
400521143Medicare PIN