Provider Demographics
NPI:1720116437
Name:SOUTHWEST INTERNISTS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST INTERNISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-771-1089
Mailing Address - Street 1:PO BOX 27608
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7608
Mailing Address - Country:US
Mailing Address - Phone:505-771-1089
Mailing Address - Fax:505-771-2581
Practice Address - Street 1:700 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2565
Practice Address - Country:US
Practice Address - Phone:505-771-1089
Practice Address - Fax:505-771-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM007D80OtherBCBS GROUP#
NM55379354Medicaid
NM55379354Medicaid