| Southwest Family Practice, Pc | |
|
304 N. Locke Ave. Farmington Farminton NM 87401 | |
| (505) 324-1100 | |
| (505) 324-1117 |
| Full Name | Southwest Family Practice, Pc |
|---|---|
| Speciality | General Practice |
| Location | 304 N. Locke Ave., Farminton, New Mexico |
| Authorized Official Name and Position | Margaret Louise Cassidy (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 5053241100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Family Practice, Pc 304 N. Locke Ave. Farmington NM 87401 Ph: (505) 324-1100 | Southwest Family Practice, Pc 304 N. Locke Ave. Farmington Farminton NM 87401 Ph: (505) 324-1100 |
| NPI Number | 1215025390 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 09/14/2011 |
| Medicare PECOS PAC ID | 0244401412 |
|---|---|
| Medicare Enrollment ID | O20110920000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215025390 | NPI | - | NPPES |
| R7312 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (New Mexico) | Secondary |
| 208D00000X | General Practice | 97-202 (New Mexico) | Primary |
| Provider Name | Margaret L Cassidy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164445326 PECOS PAC ID: 6406027739 Enrollment ID: I20110919000299 |
| Provider Name | Glenda T Pope |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669503462 PECOS PAC ID: 1254564784 Enrollment ID: I20140507000744 |
| Provider Name | Araceli Jauregui Aguilera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154985729 PECOS PAC ID: 0345578159 Enrollment ID: I20190817000007 |