Provider Demographics
NPI:1992860712
Name:SOUTHWEST HEALTH SERVICES, PA
Entity Type:Organization
Organization Name:SOUTHWEST HEALTH SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:DE LA VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-1575
Mailing Address - Street 1:2525 S TELSHOR BLVD
Mailing Address - Street 2:STE B2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5071
Mailing Address - Country:US
Mailing Address - Phone:575-521-1575
Mailing Address - Fax:575-521-1940
Practice Address - Street 1:2525 S TELSHOR BLVD
Practice Address - Street 2:STE B2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5071
Practice Address - Country:US
Practice Address - Phone:575-521-1575
Practice Address - Fax:575-521-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK2762Medicaid
NM=========Medicare ID - Type Unspecified