Healthcare Provider Details

I. General information

NPI: 1548408396
Provider Name (Legal Business Name): SOUTH WEST PEDIATRICS & ADOLESCENT MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E 11TH ST
LIBERAL KS
67901-2720
US

IV. Provider business mailing address

23 E 11TH ST
LIBERAL KS
67901-2720
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-5066
  • Fax: 620-624-2872
Mailing address:
  • Phone: 620-624-5066
  • Fax: 620-624-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33384
License Number StateKS

VIII. Authorized Official

Name: DR. NARGIS H HUSAINY
Title or Position: PEDIATRICIAN/OWNER
Credential: MD
Phone: 620-624-5066