Healthcare Provider Details

I. General information

NPI: 1073500419
Provider Name (Legal Business Name): SOUTHWESTERN REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E 79TH STREET SOUTH
TULSA OK
74133
US

IV. Provider business mailing address

5900 BROKEN SOUND PKWY NW
BOCA RATON FL
33487-2797
US

V. Phone/Fax

Practice location:
  • Phone: 918-286-5000
  • Fax: 918-286-5081
Mailing address:
  • Phone: 918-286-5000
  • Fax: 918-286-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANA HAYNIE
Title or Position: CEO
Credential:
Phone: 918-286-5793