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NPI Code Detail

MEDICARE: SOUTHWESTERN MENTAL HEALTH CENTER INC

MEDICARE: SOUTHWESTERN MENTAL HEALTH CENTER INC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)831125MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
148828SOOTHERMNBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4114833OTHERMNUCARE

General Provider Information

NPI Number : 1487654562
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWESTERN MENTAL HEALTH CENTER INC
Provider Business Mailing Address
First Line : PO BOX 686
Second Line :
City : LUVERNE
State : MN
Zip : 56156-0686
Country : US
Telephone Number : 507-283-9511
Fax Number : 507-283-9514
Provider Business Practice Location Address
First Line : 117 S SPRING ST
Second Line :
City : LUVERNE
State : MN
Zip : 56156-1916
Country : US
Telephone Number : 507-283-9511
Fax Number : 507-283-9514
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. LUKE JEROME COMEAU
Credential :
Telephone Number : 507-283-9511
Provider Enumeration Date : 07/29/2005
Last Update Date : 02/29/2024

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1154005536 — CARLY SAYLER
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1600 N KNISS AVE
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Directions to “SOUTHWESTERN MENTAL HEALTH CENTER INC ” Practice Location

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