Provider Demographics
NPI:1144493040
Name:SOUTHWEST MEDICAL CENTER
Entity type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-629-6400
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-1215
Mailing Address - Country:US
Mailing Address - Phone:620-624-0702
Mailing Address - Fax:620-624-5078
Practice Address - Street 1:305 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-0702
Practice Address - Fax:620-624-5078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-11
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST00456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200665790AMedicaid
KS110607Medicare PIN