Provider Demographics
NPI:1073599502
Name:SOUTHWESTERN INTERNAL MEDICINE ASSOC INC
Entity Type:Organization
Organization Name:SOUTHWESTERN INTERNAL MEDICINE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:FINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAFP
Authorized Official - Phone:614-274-7799
Mailing Address - Street 1:4310 CLIME RD
Mailing Address - Street 2:STE B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-3496
Mailing Address - Country:US
Mailing Address - Phone:614-274-7799
Mailing Address - Fax:614-274-3209
Practice Address - Street 1:4310 CLIME RD
Practice Address - Street 2:STE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3496
Practice Address - Country:US
Practice Address - Phone:614-274-7799
Practice Address - Fax:614-274-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 03 8463 F207R00000X
OH35 03 7445 A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384892Medicaid
OH0384892Medicaid