MEDICARE: SOUTHWEST CENTER FOR INDEPENDENT LIVING

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1538914841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST CENTER FOR INDEPENDENT LIVING

Provider Business Mailing Address
First Line	:	1450 W CAMBRIDGE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-3726
Country	:	US
Telephone Number	:	417-886-1188
Fax Number	:	417-886-3619

Provider Business Practice Location Address
First Line	:	1450 W CAMBRIDGE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-3726
Country	:	US
Telephone Number	:	417-886-1188
Fax Number	:	417-886-3619

Authorized Official
Title or Position	:	CEO
Name	:	SHANNON MARIE PORTER
Credential	:
Telephone Number	:	417-886-1188

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	04/19/2024

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Directions to “SOUTHWEST CENTER FOR INDEPENDENT LIVING ” Practice Location

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