MEDICARE: SOUTHWEST CLINIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		TX

General Provider Information

NPI Number	:	1184853020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST CLINIC, PA

Provider Business Mailing Address
First Line	:	10926 TULIP GARDEN CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3229
Country	:	US
Telephone Number	:	713-339-2684
Fax Number	:	713-339-2886

Provider Business Practice Location Address
First Line	:	6260 WESTPARK DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77057-7353
Country	:	US
Telephone Number	:	713-339-2684
Fax Number	:	713-339-2886

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AJINDER S DHATT
Credential	:	MD
Telephone Number	:	713-339-2684

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/08/2010

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