Provider Demographics
NPI:1710370309
Name:SOUTHWEST CONVENIENCE CLINIC INC
Entity Type:Organization
Organization Name:SOUTHWEST CONVENIENCE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:513-310-8742
Mailing Address - Street 1:720 W PLANE ST
Mailing Address - Street 2:UNIT 150
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-8339
Mailing Address - Country:US
Mailing Address - Phone:513-427-4057
Mailing Address - Fax:513-427-4051
Practice Address - Street 1:720 W PLANE ST
Practice Address - Street 2:UNIT 150
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-8339
Practice Address - Country:US
Practice Address - Phone:513-427-4057
Practice Address - Fax:513-427-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2371512261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care