Provider Demographics
NPI:1982025797
Name:SOUTHWEST PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:SOUTHWEST PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DI PALMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-629-3146
Mailing Address - Street 1:3950 S EASTERN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5174
Mailing Address - Country:US
Mailing Address - Phone:702-629-3146
Mailing Address - Fax:702-527-5966
Practice Address - Street 1:3950 S EASTERN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5174
Practice Address - Country:US
Practice Address - Phone:702-629-3146
Practice Address - Fax:702-527-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care