Provider Demographics
NPI:1477529030
Name:SOUTHWEST HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SOUTHWEST HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-523-5555
Mailing Address - Street 1:802 2ND ST NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623
Mailing Address - Country:US
Mailing Address - Phone:701-523-5555
Mailing Address - Fax:701-523-7107
Practice Address - Street 1:802 2ND ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623
Practice Address - Country:US
Practice Address - Phone:701-523-5555
Practice Address - Fax:701-523-7107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-24
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5006P282NC0060X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01448Medicaid
ND000497OtherHOSPITAL
ND1457848Medicaid
ND012633OtherAMBULANCE