MATHEW THERON SOUTHWICK (NPI# 1346798204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346798204 |
| Entity Type | Individual |
| Full Name | MATHEW THERON SOUTHWICK |
| Credential | P.A.-C. |
| Practice Address |
2300 E 30th St Bldg D-101 Farmington NM 87401-8991 |
| Practice Telephone | 5053271400 |
| Practice Fax Number | 5055643202 |
| Mailing Telephone | 5053271400 |
| Mailing Fax Number | 5055643202 |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2016-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | NCCPA | 1136642 | 01 |
| Street Address |
2300 E 30TH ST BLDG D-101 |
| City | FARMINGTON |
| State | NM |
| Zip Code | 87401-8991 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215011218 | Bryan Kent Broadbent | Podiatrist | 2300 E 30th St Bldg D-101, Farmington, NM 87401-8991 | 2006-10-25 |
| 1194955302 | Rena Nagl | Registered Nurse | 2300 E 30th St Bldg D-101, Farmington, NM 87401-8991 | 2009-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164035192 | Jaylene Miller | Behavior Technician | 912 Fairgrounds Rd. Trl 36, Farmington, NM 87401 | 2020-08-28 |
| 1255940326 | John Andrew Martinez | Behavioral Analyst | 211 N Auburn, Farmington, NM 87401 | 2020-07-24 |
| 1598304990 | Chasitity Beulah Nez | Behavior Technician | 37 Rd 7101 #127, Farmington, NM 87401 | 2020-01-02 |
| 1205478575 | Micah Magee | Speech-Language Pathologist | Farmington High School, 2200 N. Sunset Ave, Farmington, NM 87401 | 2019-10-08 |
| 1831659754 | Lelilah Todacheene | Social Worker | 1204 Camina Real, Farmington, NM 87401 | 2019-03-25 |
| 1306323555 | Litany of Life | Counselor | 1010 Ridgeway Place, Farmington, NM 87401 | 2018-07-20 |
| 1093291213 | Brittany Bigham | Nurse Practitioner | 1001 W Broadway Ste E, Farmington, NM 87401 | 2018-07-11 |
| 1528556305 | Hairoun Home Health | Home Health | 1200 East 20th Street, Farmington, NM 87401 | 2018-04-26 |
| 1003338732 | Silver Tongue Speech & Voice, LLC | Clinic/Center | 3001 Northridge Dr Ste C, Farmington, NM 87401 | 2017-07-14 |
| 1902256621 | Capacity Builders Inc | Taxi | 418 W Broadway, Farmington, NM 87401 | 2016-06-14 |
| Find all providers in zip 87401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366068538 | Lauren Rose Payne | Physician Assistant | 5610 State Route 96, Farmington, NY 14425-8901 | 2020-06-23 |
| 1003439936 | Lisa Petricca | Physician Assistant | 28 Berkshire Dr, Farmington, CT 06032-2506 | 2020-05-27 |
| 1710544945 | Najia Wasiuddin | Physician Assistant | 35031 Drakeshire Ln Apt 204, Farmington, MI 48335-3220 | 2019-05-22 |
| 1083189880 | Sarah E Hudson | Physician Assistant | 991 Shepard Ln Ste 200, Farmington, UT 84025-2974 | 2018-10-08 |
| 1003307109 | Jason S. Pinho | Physician Assistant | 399 Farmington Ave Ste 110, Farmington, CT 06032-1944 | 2018-05-23 |
| 1659747475 | Arsalan Ahsan | Physician Assistant | 36545 Saxony Rd, Farmington, MI 48335-3022 | 2015-08-16 |
| 1083970297 | Elizabeth Ann Putt | Physician Assistant | 33166 Maplenut St, Farmington, MI 48336-4437 | 2012-04-02 |
| 1275782997 | Sarah Marie Zimmerman | Physician Assistant | 23133 Orchard Lake Rd Ste 100, Farmington, MI 48336-3278 | 2008-09-17 |
| 1104002849 | Stephanie Behrens | Physician Assistant | 21 South Rd Ste 110, Farmington, CT 06032-2482 | 2008-01-11 |
| 1619033388 | Kathleen A. Lillicraf | Physician Assistant | John Dempsey Hospital: Dept of Anesthesiology, 263 Farmington Avenue, Mc-2015, Farmington, CT 06030-0001 | 2006-12-28 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 87401 |
Please comment or provide details below to improve the information on MATHEW THERON SOUTHWICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.