Provider Demographics
NPI:1235503384
Name:SOUTHWEST GENERAL MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SOUTHWEST GENERAL MEDICAL GROUP INC.
Other - Org Name:SOUTHWEST FAMILY PHYSICIANS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-816-2750
Mailing Address - Street 1:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8269
Mailing Address - Country:US
Mailing Address - Phone:440-816-2761
Mailing Address - Fax:
Practice Address - Street 1:7225 OLD OAK BLVD STE A210
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3339
Practice Address - Country:US
Practice Address - Phone:440-816-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST GENERAL MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-30
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9211001Medicare PIN
1942203807Medicare UPIN