Provider Demographics
NPI:1558315010
Name:SOUTHWEST HEALTHCARE OF BROWN COUNTY OHIO, LLC
Entity Type:Organization
Organization Name:SOUTHWEST HEALTHCARE OF BROWN COUNTY OHIO, LLC
Other - Org Name:SOUTHWEST REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SURAPANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-378-7800
Mailing Address - Street 1:425 HOME ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1407
Mailing Address - Country:US
Mailing Address - Phone:937-378-7500
Mailing Address - Fax:937-378-7808
Practice Address - Street 1:425 HOME ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1407
Practice Address - Country:US
Practice Address - Phone:937-378-7500
Practice Address - Fax:937-378-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1115282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050714Medicaid
OH1037667Medicaid
OHH021630Medicare Oscar/Certification
OH360116Medicare Oscar/Certification