Provider Demographics
NPI:1912233420
Name:SOUTHWEST TRAUMA SOLUTIONS LLC
Entity Type:Organization
Organization Name:SOUTHWEST TRAUMA SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LCSW
Authorized Official - Phone:575-654-0812
Mailing Address - Street 1:204A W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5370
Mailing Address - Country:US
Mailing Address - Phone:575-654-0812
Mailing Address - Fax:
Practice Address - Street 1:204A W MARKET ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5370
Practice Address - Country:US
Practice Address - Phone:575-654-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-066571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28077059Medicaid