1962851253 NPI number — SOUTHWESTERN MENTAL HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962851253 NPI number — SOUTHWESTERN MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN MENTAL 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:
Provider Other Organization Name Type Code:
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:
1962851253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 S SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUVERNE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56156-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-283-9511
Provider Business Mailing Address Fax Number:
507-283-9514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 S SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUVERNE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56156-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-283-9511
Provider Business Practice Location Address Fax Number:
507-283-9514
Provider Enumeration Date:
06/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VINZANT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE SERVICES DIRECTOR
Authorized Official Telephone Number:
507-283-9511

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  21451 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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