Provider Demographics
NPI:1942691399
Name:SOUTHWEST PRIMARY CARE LTD
Entity Type:Organization
Organization Name:SOUTHWEST PRIMARY CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANU
Authorized Official - Middle Name:
Authorized Official - Last Name:LONIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-329-9816
Mailing Address - Street 1:5932 E PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-9223
Mailing Address - Country:US
Mailing Address - Phone:630-329-9816
Mailing Address - Fax:
Practice Address - Street 1:3200 N DOBSON RD
Practice Address - Street 2:SUITE F-5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9601
Practice Address - Country:US
Practice Address - Phone:630-329-9816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ19770524OtherCORPORATION NUMBER