Healthcare Provider Details

I. General information

NPI: 1386658045
Provider Name (Legal Business Name): SOUTHWEST MEDICAL CENTER-CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WILSON RD
BENTLEYVILLE PA
15314-1027
US

IV. Provider business mailing address

119 WILSON RD
BENTLEYVILLE PA
15314-1027
US

V. Phone/Fax

Practice location:
  • Phone: 724-239-4700
  • Fax: 724-239-3262
Mailing address:
  • Phone: 724-239-4700
  • Fax: 724-239-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD043417
License Number StatePA

VIII. Authorized Official

Name: KAMLELSH B GOSAI
Title or Position: CEO OWNER
Credential: MD
Phone: 724-239-4700