Provider Demographics
NPI:1114914140
Name:SOUTHWEST HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SOUTHWEST HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-523-3214
Mailing Address - Street 1:802 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-4483
Mailing Address - Country:US
Mailing Address - Phone:701-523-3214
Mailing Address - Fax:701-523-4139
Practice Address - Street 1:802 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4483
Practice Address - Country:US
Practice Address - Phone:701-523-3214
Practice Address - Fax:701-523-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1007B314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND001289OtherBLUE CROSS BLUE SHIELD
ND30403Medicaid
ND001289OtherBLUE CROSS BLUE SHIELD