MEDICARE: SOUTHWEST FAMILY CARE ALLIANCE

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1386959245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FAMILY CARE ALLIANCE

Provider Business Mailing Address
First Line	:	28526 US HWY 14
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-5114
Country	:	US
Telephone Number	:	608-647-4729
Fax Number	:	608-649-4728

Provider Business Practice Location Address
First Line	:	28526 US HWY 14
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-5114
Country	:	US
Telephone Number	:	608-647-4729
Fax Number	:	608-649-4728

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TERI BUROS
Credential	:
Telephone Number	:	608-647-4729

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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