Provider Demographics
NPI:1376583997
Name:SOUTHWEST MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER
Other - Org Name:SWMC PSYCHIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-629-6400
Mailing Address - Street 1:315 W 15TH STREET
Mailing Address - Street 2:PO BOX 1340
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-1340
Mailing Address - Country:US
Mailing Address - Phone:620-629-6758
Mailing Address - Fax:620-629-2472
Practice Address - Street 1:315 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-629-6578
Practice Address - Fax:620-629-2472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110860Medicare ID - Type UnspecifiedPROFESSIONAL GROUP