Healthcare Provider Details

I. General information

NPI: 1023083714
Provider Name (Legal Business Name): SOUTHWEST HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 2ND ST NW
BOWMAN ND
58623-4483
US

IV. Provider business mailing address

802 2ND ST NW STE 1
BOWMAN ND
58623-4469
US

V. Phone/Fax

Practice location:
  • Phone: 701-523-5555
  • Fax: 701-523-7107
Mailing address:
  • Phone: 701-523-5555
  • Fax: 701-523-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA KNOPP
Title or Position: CLINIC MANAGER
Credential:
Phone: 701-523-5555