Provider Demographics
NPI:1548408396
Name:SOUTH WEST PEDIATRICS & ADOLESCENT MEDICINE PA
Entity Type:Organization
Organization Name:SOUTH WEST PEDIATRICS & ADOLESCENT MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARGIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUSAINY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-5066
Mailing Address - Street 1:23 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2720
Mailing Address - Country:US
Mailing Address - Phone:620-624-5066
Mailing Address - Fax:620-624-2872
Practice Address - Street 1:23 E 11TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2720
Practice Address - Country:US
Practice Address - Phone:620-624-5066
Practice Address - Fax:620-624-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS33384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty