Provider Demographics
NPI:1588829410
Name:SOUTHWEST PHYSICIANS GROUP-HMO SITE
Entity Type:Organization
Organization Name:SOUTHWEST PHYSICIANS GROUP-HMO SITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-425-4488
Mailing Address - Street 1:4861 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2521
Mailing Address - Country:US
Mailing Address - Phone:708-425-4488
Mailing Address - Fax:
Practice Address - Street 1:4861 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2521
Practice Address - Country:US
Practice Address - Phone:708-425-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization