Provider Demographics
NPI:1548279557
Name:SOUTHWEST MEDICAL CENTER-RADIOLOGY
Entity type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER-RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-239-4700
Mailing Address - Street 1:119 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1027
Mailing Address - Country:US
Mailing Address - Phone:724-239-4700
Mailing Address - Fax:724-239-3262
Practice Address - Street 1:119 WILSON RD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1027
Practice Address - Country:US
Practice Address - Phone:724-239-4700
Practice Address - Fax:724-239-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017650E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD017650EOtherLICENSE
PAMD043417OtherLICENSE
PAE64044Medicare UPIN
PAMD017650EOtherLICENSE