Provider Demographics
NPI:1639137870
Name:SOUTHWEST KANSAS CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:SOUTHWEST KANSAS CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-225-3900
Mailing Address - Street 1:100 W ROSS BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7217
Mailing Address - Country:US
Mailing Address - Phone:620-225-3900
Mailing Address - Fax:620-225-3901
Practice Address - Street 1:100 W ROSS BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7217
Practice Address - Country:US
Practice Address - Phone:620-225-3900
Practice Address - Fax:620-225-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111186Medicare ID - Type UnspecifiedGROUP NUMBER