Tina J Southward, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

95-PA10 Issued in NM

Practice address

75 Univeristy Blvd
Ste 130
Roswell, NM 88203

Phone

(575) 624-7207

NPI assigned

Aug 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tina J Wilcox Former name

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tsouthward98643@direct.phs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Presbyterian Healthcare Services

  dba Lincoln County Medical Center

  • Critical Access Hospital
  • Ruidoso, NM
  • NPI 1558347708
  Medicare reassignment NPD
• Presbyterian Healthcare Services

  dba Presbyterian Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1215913470
  NPD
• New Mexico Heart Institute, LLC

  • Cardiovascular Disease Physician
  • Albuquerque, NM
  • NPI 1346242575
  NPD (past)
• Roswell Clinic Corp

  • Family Medicine Physician
  • Roswell, NM
  • NPI 1649267618
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1164434387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1574",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882021574",
            "telephone_number": "575-624-3470",
            "fax_number": "575-627-9520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 UNIVERISTY BLVD",
            "address_2": "STE 130",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "88203",
            "telephone_number": "575-624-7207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 W Country Club Rd",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "882015209",
            "country_code": "US",
            "telephone_number": "575-627-9110",
            "fax_number": "575-623-2191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHWARD",
        "first_name": "TINA",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "95-PA10",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "WILCOX",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Louriz Soto
• Southeastern New Mexico Speech and Hearing Clinic (Audio Acoustics Hearing Center)
• Southeastern New Mexico Surgical Center, LLC (Center for Ambulatory Surgery and Endoscopy of Southeastern New Mexico)
• Southern Counseling and Psychological Services LLC
• Southern New Mexico Medical Association, PA
• Southwest Ambulance of New Mexico
• Southwest C a R E Center
• Southwest Medical Associates, LLC
• Kathleen Sova
• Sparkman Behavioral Health, P. C.

• Medical Physician Assistant in Roswell, NM
• Providers in Roswell, NM by specialty
• Medical Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.