Provider Demographics
NPI:1124216874
Name:SOUTHWEST LITHOTRIPSY
Entity Type:Organization
Organization Name:SOUTHWEST LITHOTRIPSY
Other - Org Name:AKSM/SOUTHWEST LITHOTRIPSY
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS/AKSM
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1800-637-5188
Mailing Address - Street 1:797 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3903
Mailing Address - Country:US
Mailing Address - Phone:800-637-5188
Mailing Address - Fax:866-717-2280
Practice Address - Street 1:797 THOMAS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3903
Practice Address - Country:US
Practice Address - Phone:800-637-5188
Practice Address - Fax:866-717-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy