Basic Information
| Provider Information | |||||||||
| NPI: | 1154353993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST GENERAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18697 BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408168000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18697 BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408168000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LINSON | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 4408168071 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000000076347 | 01 | ANTHEM | OTHER | 18120 | 01 | QUALCHOICE | OTHER | 0065710 | 01 | AETNA | OTHER | 1508074 | 01 | UNITED MINE WORKERS | OTHER | 5000079 | 01 | UNITED HEALTHCARE | OTHER | 8295509 | 05 | OH | MEDICAID |