Provider Demographics
NPI:1356386007
Name:SOUTHWEST EMERGENCY PHYSICIANS, PC
Entity type:Organization
Organization Name:SOUTHWEST EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-532-8800
Mailing Address - Street 1:3850 FOOTHILLS RD
Mailing Address - Street 2:STE 9
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4632
Mailing Address - Country:US
Mailing Address - Phone:505-532-8800
Mailing Address - Fax:505-532-5920
Practice Address - Street 1:4311 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8255
Practice Address - Country:US
Practice Address - Phone:505-532-8800
Practice Address - Fax:505-532-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM04208510Medicaid