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TINA J SOUTHWARD PAC
NPI 1164434387
Physician Assistant - Medical in Roswell, NM

Active since August 13, 2006PECOS Enrolled
75 UNIVERISTY BLVD, STE 130, ROSWELL, NM 88203(575) 624-7207 Get Directions Write a Review

NPPES record last updated: July 12, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 12, 2019, Nov 30, 2017, Jan 26, 2017 (3 updates tracked since 2017).

About Tina J Southward Pac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TINA J SOUTHWARD PAC (NPI 1164434387) is an individual medical provider in Roswell, New Mexico, licensed in New Mexico (95-PA10) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Roswell.

NPPES Registry Identity

NPI1164434387
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameTINA J SOUTHWARDCredential: PAC
Location Address75 UNIVERISTY BLVD, STE 130Roswell, NM 88203
Mailing AddressPo Box 1574Roswell, NM 88202-1574 · (575) 624-3470 · Fax (575) 627-9520
Phone(575) 624-7207
Sole ProprietorNo
Enumeration DateAugust 13, 2006
Last NPPES UpdateJuly 12, 20193 updates tracked since enumeration
✔ NPI 1164434387 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NM · 95-PA10
75 UNIVERISTY BLVD, Roswell, NM 88203
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Other Names 1

Former Name (1)Tina J Wilcox

Secondary Practice Location 1

Location 1407 W Country Club RdRoswell, NM 88201-5209 · Phone (575) 627-9110 · Fax (575) 623-2191

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tina J Southward Pac is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tina Southward's NPI number?

The NPI number for Tina Southward is 1164434387. It was assigned to this individual provider in the NPPES registry on August 13, 2006. The provider is also known as Tina J Wilcox.

Where is Tina Southward located?

Tina Southward practices at 75 Univeristy Blvd Ste 130, Roswell, NM 88203. The listed phone number is (575) 624-7207.

What is Tina Southward's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Tina Southward enrolled in Medicare?

Yes. Tina Southward is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tina Southward was last updated on July 12, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.