Healthcare Provider Details

I. General information

NPI: 1740608306
Provider Name (Legal Business Name): SOUTHWEST GENERAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
CLEVELAND OH
44130-3417
US

IV. Provider business mailing address

PO BOX 632701
CINCINNATI OH
45263-2701
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-8000
  • Fax:
Mailing address:
  • Phone: 440-879-0081
  • Fax: 440-879-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM YOUNG JR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 440-816-6701