Southwestern Emergency Department Physician Services, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

2231 Issued in OK

Legal business name

SOUTHWESTERN EMERGENCY DEPARTMENT PHYSICIAN SERVICES, LLC

Practice address

5602 SW Lee Blvd
Lawton, OK 73505-9635

Phone

(580) 531-4700

Fax

(580) 531-4889

NPI assigned

Aug 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. George Kruger

Title

Chief Financial Officer

Phone

(580) 531-4701

Specialties & licenses 1

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Southwestern Medical Center, LLC

  dba Southwestern Medical Center

  • General Acute Care Hospital
  • Lawton, OK
  • NPI 1952359986

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255344206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "SUITE 121",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-751-4664",
            "fax_number": "405-749-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5602 SW LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059635",
            "telephone_number": "580-531-4700",
            "fax_number": "580-531-4889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN EMERGENCY DEPARTMENT PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KRUGER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "580-531-4701",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "2231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Jean Southern
• Southwest Anesthesia - Service of Comanche County Memorial Hospital
• Southwest Imaging Center Inc
• Southwest LTC Lawton LLC (Willow Park Healthcare Center)
• Southwest Oral & Maxillofacial Surgery
• Southwestern Home Health, Inc.
• Southwestern Home Health, Inc.
• Southwestern Home Health, Inc.
• Southwestern Medical Associates, P.C.
• Southwestern Medical Center

• Primary Care Clinic/Center in Lawton, OK
• Providers in Lawton, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.