Southwest Medical Clinic Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R37006 Issued in NM

Legal business name

SOUTHWEST MEDICAL CLINIC INC

Practice address

2230 Bosque Farms Blvd
Bosque Farms, NM 87068-9334

Phone

(505) 869-0300

NPI assigned

Jan 30, 2009

Last updated

May 26, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Fatemeh Mansoori, FNPNPI 1346335759

Title

Owner/ Provider

Phone

(505) 869-0300

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fatemeh Mansoori, C.F.N.P

  • Family Medicine Physician
  • Bosque Farms, NM
  • NPI 1346335759
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1144468075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 BOSQUE FARMS BLVD",
            "city": "BOSQUE FARMS",
            "state": "NM",
            "postal_code": "870689334",
            "telephone_number": "505-975-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 BOSQUE FARMS BLVD",
            "city": "BOSQUE FARMS",
            "state": "NM",
            "postal_code": "870689334",
            "telephone_number": "505-869-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "MANSOORI",
        "authorized_official_first_name": "FATEMEH",
        "authorized_official_title_or_position": "OWNER/ PROVIDER",
        "authorized_official_telephone_number": "505-869-0300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "R37006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25079310",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "349531402",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Robinson
• Korah Makayla Roybal
• Myles Sandoval
• Stacie Shain, D.O.M
• Matthew Smith, LMSW
• Martha Brown Swinney, MA, CCC-SLP
• Teekees Clinic
• Michelle Kathryn Williams-Gabaldon, MS, CCC-SLP

• Family Nurse Practitioner in Bosque Farms, NM
• Providers in Bosque Farms, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.