Provider Demographics
NPI:1275710261
Name:SOUTHWEST HOME MEDICAL CARE SERVICES, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST HOME MEDICAL CARE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLADIMEJI
Authorized Official - Middle Name:OLUMIDE
Authorized Official - Last Name:SORUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:817-723-3638
Mailing Address - Street 1:2012 KALGARY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8869
Mailing Address - Country:US
Mailing Address - Phone:817-723-3638
Mailing Address - Fax:817-453-1181
Practice Address - Street 1:2012 KALGARY LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8869
Practice Address - Country:US
Practice Address - Phone:817-723-3638
Practice Address - Fax:817-453-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty