Provider Demographics
NPI:1609336460
Name:SOUTHWEST CARE CENTER
Entity type:Organization
Organization Name:SOUTHWEST CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-216-0333
Mailing Address - Street 1:4710 JEFFERSON ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2156
Mailing Address - Country:US
Mailing Address - Phone:505-780-4044
Mailing Address - Fax:
Practice Address - Street 1:901 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1681
Practice Address - Country:US
Practice Address - Phone:505-780-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy