Basic Information
| Provider Information | |||||||||
| NPI: | 1407953573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWEA, P.C. | ||||||||
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| OtherOrganizationName: | SOUTHWEST EMERGENCY ASSOCIATES, P.C. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 E PIMA ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203822819 | ||||||||
| FaxNumber: | 5203822832 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 E GRANT RD | ||||||||
| Address2: | TMC EMERGENCY DEPARTMENT | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203241922 | ||||||||
| FaxNumber: | 5203241088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COMPTON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5203241922 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | AZ0035930 | 01 | AZ | BCBS GROUP PIN | OTHER | C12342 | 01 | RAILROAD MEDICARE GROUP # | OTHER | IZ6811 | 01 | AZ | HEALTHNET GROUP # | OTHER |