Provider Demographics
NPI:1700110988
Name:SOUTHWESTERN MEDICAL CENTERS INC - AZ
Entity Type:Organization
Organization Name:SOUTHWESTERN MEDICAL CENTERS INC - AZ
Other - Org Name:THUMB BUTTE OUTPATIENT REHAB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-828-5686
Mailing Address - Street 1:1020 NE LOOP 410
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1204
Mailing Address - Country:US
Mailing Address - Phone:210-828-5686
Mailing Address - Fax:
Practice Address - Street 1:864 DOUGHERTY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1841
Practice Address - Country:US
Practice Address - Phone:928-778-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 4666261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy