Provider Demographics
NPI:1942203807
Name:SOUTHWEST FAMILY PHYSICIANS, INC.
Entity Type:Organization
Organization Name:SOUTHWEST FAMILY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-816-2750
Mailing Address - Street 1:7225 OLD OAK BLVD
Mailing Address - Street 2:STE A210
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3339
Mailing Address - Country:US
Mailing Address - Phone:440-816-2750
Mailing Address - Fax:
Practice Address - Street 1:7225 OLD OAK BLVD
Practice Address - Street 2:STE A210
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3339
Practice Address - Country:US
Practice Address - Phone:440-816-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074996A207Q00000X
OH35077155D207Q00000X
OH35078742W207Q00000X
OH35069313A207Q00000X
OH35052685207Q00000X
OH35038312207Q00000X
OH35042476207Q00000X
OH35037697T207Q00000X
OH35089320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0245970Medicaid
OH=========00OtherWORKERS COMP
OH0433370001Medicare NSC
OH=========00OtherWORKERS COMP