SOUTHWEST PEDIATRIC AND FAMILY CARE LLC NPI 1881089886

NPI Information

NPI: 1881089886
Provider Name: SOUTHWEST PEDIATRIC AND FAMILY CARE, LLC

Doing Business As: SOUTHWEST PEDIATRIC CARE, LLC

Classification:
Entity Type: Organization

Address:
1020 S 8TH ST
SUITE A
DEMING, NM
ZIP 88030
Phone: (575) 936-4350
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SOUTHWEST PEDIATRIC AND FAMILY CARE, LLC is a healthcare provider in Deming, NM. SOUTHWEST PEDIATRIC AND FAMILY CARE, LLC NPI is 1881089886. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southwest Pediatric Care, Llc.

The provider's business location address is:

1020 S 8TH ST
SUITE A
DEMING, NM
ZIP 88030-007
Phone: (575) 936-4350
Fax: (575) 936-4351

The provider's authorized official is Joel Rene Roque .
The authorized official title is Coo / Co-owner and has the following contact phone number (575) 936-4350.

The CLIA number assigned to this NPI record is 32D2110182 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2015 and was last updated on 10/21/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	CNP01614	NEW MEXICO	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	48836893	MEDICAID	NEW MEXICO
2	965048	MEDICAID	ARIZONA
3	5558582	MEDICAID	NEW MEXICO
4	1376626564	OTHER	ARIZONA	TYPE 1 NPI FLORENCE C ROQUE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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