Provider Demographics
NPI:1043316235
Name:SWWC SERVICE COOPERATIVES
Entity Type:Organization
Organization Name:SWWC SERVICE COOPERATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-537-2284
Mailing Address - Street 1:1420 E COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258
Mailing Address - Country:US
Mailing Address - Phone:507-537-2240
Mailing Address - Fax:507-537-6868
Practice Address - Street 1:1420 E COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-537-2240
Practice Address - Fax:507-537-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN587355000Medicaid