Provider Demographics
NPI:1689622615
Name:SOUTHWESTERN MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN MEDICAL CENTER, LLC
Other - Org Name:SOUTHWESTERN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9800
Mailing Address - Street 1:5602 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9635
Mailing Address - Country:US
Mailing Address - Phone:580-531-4700
Mailing Address - Fax:580-531-4702
Practice Address - Street 1:1602 SW 82ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9012
Practice Address - Country:US
Practice Address - Phone:580-536-0077
Practice Address - Fax:580-510-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2231273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100697950Medicaid
37-S097Medicare Oscar/Certification