Healthcare Provider Details

I. General information

NPI: 1104026079
Provider Name (Legal Business Name): SWEETWATER-NOLAN CO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E 7TH ST
ROTAN TX
79546-2317
US

IV. Provider business mailing address

PO BOX 457
SWEETWATER TX
79556-0457
US

V. Phone/Fax

Practice location:
  • Phone: 325-235-2869
  • Fax: 325-236-6856
Mailing address:
  • Phone: 325-235-2869
  • Fax: 325-236-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberG2615
License Number StateTX

VIII. Authorized Official

Name: HARVEY DON WARE
Title or Position: DIRECTOR
Credential:
Phone: 325-235-2869