Provider Demographics
NPI:1700873601
Name:SOUTHWEST HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:SOUTHWEST HEALTH AND HUMAN SERVICES
Other - Org Name:LLMP PUBLIC HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-537-6747
Mailing Address - Street 1:607 WEST MAIN STREET STE 100
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3021
Mailing Address - Country:US
Mailing Address - Phone:507-537-6747
Mailing Address - Fax:507-537-6088
Practice Address - Street 1:607 WEST MAIN STREET STE 200
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3021
Practice Address - Country:US
Practice Address - Phone:507-537-6709
Practice Address - Fax:507-537-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN328753000Medicaid
MN8214LIMedicare UPIN
MN328753000Medicaid
MN030726017Medicare UPIN
MN114319Medicare UPIN