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General NPI Number Information
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NPI Number | 1710370309
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Entity Type | Organization
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Legal Business Name | SOUTHWEST CONVENIENCE CLINIC INC
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 06/07/2015
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Provider Practice Location Address
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Address Line | 720 W PLANE ST UNIT 150
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City | BETHEL
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State | OH
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Zip | 45106-8339
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Country | US
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Telephone | 513-427-4057
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Fax | 513-427-4051
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Provider Business Mailing Address
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Address Line | 720 W PLANE ST UNIT 150
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City | BETHEL
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State | OH
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Zip | 45106-8339
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Country | US
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Telephone | 513-427-4057
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Fax | 513-427-4051
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRACY DAWN DUNN
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Credential | CNP
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Telephone | 513-310-8742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 2371512
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License Number State | OH
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