Provider Demographics
NPI:1952310732
Name:S.W.I.M. P.C.
Entity Type:Organization
Organization Name:S.W.I.M. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SIGALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-243-2323
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-243-2323
Mailing Address - Fax:
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-243-2323
Practice Address - Fax:505-243-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ1044Medicaid
NMJ1044Medicaid