MEDICARE: SOUTHWEST COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1043618309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	5705 W 65TH ST
Second Line	:	SUITE C
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-3827
Country	:	US
Telephone Number	:	501-779-3528
Fax Number	:	501-582-4208

Provider Business Practice Location Address
First Line	:	5705 W 65TH ST
Second Line	:	SUITE C
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-3827
Country	:	US
Telephone Number	:	501-779-3528
Fax Number	:	501-562-4208

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. CHARLESETTA HARVILLE
Credential	:
Telephone Number	:	501-799-3528

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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