Healthcare Provider Details

I. General information

NPI: 1447294145
Provider Name (Legal Business Name): SOUTHWEST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 15TH STREET
LIBERAL KS
67901-2455
US

IV. Provider business mailing address

315 W 15TH STREET PO BOX 1340
LIBERAL KS
67905-1340
US

V. Phone/Fax

Practice location:
  • Phone: 620-624-1651
  • Fax: 620-629-2474
Mailing address:
  • Phone: 620-624-1651
  • Fax: 620-629-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. DELANY FAWKES
Title or Position: CFO/VP OF FINANCE
Credential:
Phone: 620-629-6300