Provider Demographics
NPI:1144260753
Name:SOUTHWEST MEDICAL CENTER
Entity type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DELANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-629-6300
Mailing Address - Street 1:315 W 15TH STREET
Mailing Address - Street 2:PO BOX 1340
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-1340
Mailing Address - Country:US
Mailing Address - Phone:620-624-1651
Mailing Address - Fax:620-629-2472
Practice Address - Street 1:315 W 15TH STREET
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901
Practice Address - Country:US
Practice Address - Phone:620-624-1651
Practice Address - Fax:620-629-2472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016426Medicare ID - Type UnspecifiedPROFESSIONAL GROUP