1922057892 NPI number — SOUTHWEST SPINE & ORTHOPEDIC CLINIC PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922057892 NPI number — SOUTHWEST SPINE & ORTHOPEDIC CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST SPINE & ORTHOPEDIC CLINIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922057892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87499-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-327-0333
Provider Business Mailing Address Fax Number:
505-327-0159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 E 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-327-0333
Provider Business Practice Location Address Fax Number:
505-327-0159
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALTZMAN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
MORRIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-327-0333

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  84-252 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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