Provider Demographics
NPI:1477780955
Name:SOUTHWEST MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER
Other - Org Name:CANUCK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-624-1651
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905
Mailing Address - Country:US
Mailing Address - Phone:620-624-0142
Mailing Address - Fax:620-624-2660
Practice Address - Street 1:1411 W. 15TH STREET
Practice Address - Street 2:STE. 102
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901
Practice Address - Country:US
Practice Address - Phone:620-624-0142
Practice Address - Fax:620-624-0142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST MEDICAL CENTER DBA CANUCK MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-11
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QP2300X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care