Provider Demographics
NPI:1043204118
Name:SOUTHWEST INTERNAL MEDICINE, P. C.
Entity type:Organization
Organization Name:SOUTHWEST INTERNAL MEDICINE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-628-9200
Mailing Address - Street 1:736 S 900 E
Mailing Address - Street 2:STE 104
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7000
Mailing Address - Country:US
Mailing Address - Phone:435-628-9200
Mailing Address - Fax:435-674-5763
Practice Address - Street 1:736 S 900 E
Practice Address - Street 2:SUITE 104
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7000
Practice Address - Country:US
Practice Address - Phone:435-628-9200
Practice Address - Fax:435-674-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0055972Medicare ID - Type Unspecified