1376579532 NPI number — SOUTHWEST GENERAL HEALTH CENTER

Table of content: (NPI 1376579532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376579532 NPI number — SOUTHWEST GENERAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST GENERAL HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OAKVIEW MENTAL HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376579532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18697 BAGLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-816-8071
Provider Business Mailing Address Fax Number:
440-816-6716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7265 OLD OAK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-816-8179
Provider Business Practice Location Address Fax Number:
440-816-8197
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LINSON
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
440-816-8071

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18120 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0065710 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1508074 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5035374 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8295509 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000076347 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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