Provider Demographics
NPI:1164755179
Name:SOUTHWEST HEALTHCARE OF BROWN COUNTY OHIO, LLC
Entity Type:Organization
Organization Name:SOUTHWEST HEALTHCARE OF BROWN COUNTY OHIO, LLC
Other - Org Name:SOUTHWEST REGIONAL MEDICAL CENTER - BETHEL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SURAPANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-378-7800
Mailing Address - Street 1:210 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-1124
Mailing Address - Country:US
Mailing Address - Phone:513-734-9050
Mailing Address - Fax:513-734-9051
Practice Address - Street 1:210 N UNION ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-1124
Practice Address - Country:US
Practice Address - Phone:513-734-9050
Practice Address - Fax:513-734-9051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST HEALTHCARE OF BROWN COUNTY OHIO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1115261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1902940042OtherNPI
OH363981Medicare Oscar/Certification