Provider Demographics
NPI:1295947943
Name:SOUTHWESTERN CRITICAL CARE MEDICINE PLLC
Entity type:Organization
Organization Name:SOUTHWESTERN CRITICAL CARE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-317-9100
Mailing Address - Street 1:PO BOX 6935
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2545
Mailing Address - Country:US
Mailing Address - Phone:928-317-9100
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-317-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z115925Medicare PIN