Basic Information
| Provider Information | |||||||||
| NPI: | 1902808603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST PERFUSION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27588 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852857588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807770900 | ||||||||
| FaxNumber: | 4807771345 | ||||||||
| Practice Location | |||||||||
| Address1: | 5801 S MCCLINTOCK DR | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852836002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807770900 | ||||||||
| FaxNumber: | 4807771345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | COLSON | ||||||||
| AuthorizedOfficialFirstName: | MISSY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4807770900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 242T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Perfusionist |
No ID Information.