Provider Demographics
NPI:1912001918
Name:SOUTHWEST IOWA MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:SOUTHWEST IOWA MEDICAL SERVICES INC
Other - Org Name:SOUTHWEST IOWA MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-382-1515
Mailing Address - Street 1:2959 US HIGHWAY 275
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:IA
Mailing Address - Zip Code:51640
Mailing Address - Country:US
Mailing Address - Phone:712-382-1515
Mailing Address - Fax:712-382-2023
Practice Address - Street 1:1201 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1872
Practice Address - Country:US
Practice Address - Phone:712-527-1301
Practice Address - Fax:712-527-1302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST IOWA MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-11
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0196105Medicaid
IA23572OtherBLUE CROSS BLUE SHIELD