Provider Demographics
NPI:1891893624
Name:SOUTHWEST HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SOUTHWEST HEALTHCARE SERVICES
Other - Org Name:SOUTHWEST MEDICAL CLINIC RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPTON
Authorized Official - Suffix:
Authorized Official - Credentials:CLINIC
Authorized Official - Phone:701-523-3226
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-0009
Mailing Address - Country:US
Mailing Address - Phone:701-523-3226
Mailing Address - Fax:701-523-7107
Practice Address - Street 1:12 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4518
Practice Address - Country:US
Practice Address - Phone:701-523-3226
Practice Address - Fax:701-523-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND09274OtherRURAL HEALTH CLINIC
ND05145Medicaid
ND05145Medicaid