NPIMap

Organization Active NPI

Southwest Sport and Spine Center Inc

  • Physical Therapist
  • Las Cruces, NM
National Provider Identifier
1164475208
Registry record updated May 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTHWEST SPORT AND SPINE CENTER INC
Practice address
2404 S Locust St
Ste 5
Las Cruces, NM 88001-5789
Phone
(505) 521-4188
Fax
(505) 521-3668
NPI assigned
May 18, 2006
Last updated
May 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2008

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

Authorized official

Name
Mrs. Laurie Denise Campbell, PTNPI 1922057330
Title
Director
Phone
(505) 521-4188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2404 S Locust St
Ste 5
Las Cruces, NM 88001-5789

Mailing address

2404 S Locust St
Ste 5
Las Cruces, NM 88001-5789
Phone (505) 521-4188

Other identifiers 1

IdentifierTypeStateIssuer
18402828MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040120000939 NM Part B Supplier - Clinic/Group Practice 5496656563 Receives reassigned benefits from 24 practitioners
Practice locations: Las Cruces, NM
O20160601000273 TX Part B Supplier - Clinic/Group Practice 5496656563 Receives reassigned benefits from 15 practitioners
Practice locations: Canutillo, TX; El Paso, TX

National Provider Directory

National Provider Directory

Locations

2404 S Locust St
Las Cruces, NM 88001
Phone (575) 521-4188

2404 S Locust St
Ste 5
Las Cruces, NM 88001
Phone (505) 521-4188

2650 E Idaho Ave
Ste E
Las Cruces, NM 88011
Phone (505) 521-4188

900 Talbot Ave
Ste H
El Paso, TX 79835
Phone (575) 215-1580

Practitioners & affiliated clinicians

Practitioners 61

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.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1164475208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 S LOCUST ST",
            "address_2": "STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789",
            "telephone_number": "505-521-4188",
            "fax_number": "505-521-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 S LOCUST ST",
            "address_2": "STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789",
            "telephone_number": "505-521-4188",
            "fax_number": "505-521-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST SPORT AND SPINE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "505-521-4188",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18402828",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.