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NPI Code Detail

MEDICARE: SOUTHWEST GENERAL MEDICAL GROUP, INC.

MEDICARE: SOUTHWEST GENERAL MEDICAL GROUP, 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
12084P0800XPsychiatry Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DA4203OTHEROHRAILROAD MEDICARE
4CA1078OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588713341
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWEST GENERAL MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 638269
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-0001
Country : US
Telephone Number : 440-816-5790
Fax Number :
Provider Business Practice Location Address
First Line : 7265 OLD OAK BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44130-3342
Country : US
Telephone Number : 440-816-5790
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : HEATHER WAGNER
Credential :
Telephone Number : 440-816-4906
Provider Enumeration Date : 01/10/2007
Last Update Date : 05/11/2020

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Directions to “SOUTHWEST GENERAL MEDICAL GROUP, INC. ” Practice Location

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