Provider Demographics
NPI:1902931728
Name:SOUTHWEST GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-999-1600
Mailing Address - Street 1:7788 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4342
Mailing Address - Country:US
Mailing Address - Phone:505-999-1600
Mailing Address - Fax:505-999-1650
Practice Address - Street 1:7788 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4342
Practice Address - Country:US
Practice Address - Phone:505-999-1600
Practice Address - Fax:505-999-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01165766009174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========Medicare ID - Type UnspecifiedPROVIDER NUMBER
NM3=========Medicare UPIN
NMNMSGA-2DAMedicare ID - Type UnspecifiedSUBMITTER CODE