Provider Demographics
NPI:1023083714
Name:SOUTHWEST HEALTH CARE SERVICES
Entity type:Organization
Organization Name:SOUTHWEST HEALTH CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-523-5555
Mailing Address - Street 1:802 2ND ST NW STE 1
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-4469
Mailing Address - Country:US
Mailing Address - Phone:701-523-5555
Mailing Address - Fax:701-523-7107
Practice Address - Street 1:802 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4483
Practice Address - Country:US
Practice Address - Phone:701-523-5555
Practice Address - Fax:701-523-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11469Medicaid
MN1134779-00Medicaid
ND11469Medicaid
NDN71076Medicare ID - Type Unspecified
MN1134779-00Medicaid
MT82487Medicare ID - Type Unspecified