Provider Demographics
NPI:1497795017
Name:SOUTHWEST MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER
Other - Org Name:SOUTHWEST HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DELANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-629-6300
Mailing Address - Street 1:324 W 18TH 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:620-629-6878
Mailing Address - Fax:620-629-2472
Practice Address - Street 1:324 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2466
Practice Address - Country:US
Practice Address - Phone:620-629-6878
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:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS18512OtherBLUESHIELD
OK18516OtherBLUESHIELD
OK18516OtherBLUESHIELD