Healthcare Provider Details

I. General information

NPI: 1700873601
Provider Name (Legal Business Name): SOUTHWEST HEALTH AND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WEST MAIN STREET STE 200
MARSHALL MN
56258-3021
US

IV. Provider business mailing address

607 WEST MAIN STREET STE 100
MARSHALL MN
56258-3021
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-6709
  • Fax: 507-537-6719
Mailing address:
  • Phone: 507-537-6747
  • Fax: 507-537-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BETH WILMS
Title or Position: DIRECTOR
Credential:
Phone: 507-537-6747