Southwest Medical Center
Organization Active NPI Skilled Nursing Facility · Liberal, KS
NPI 1407890692 · NPPES record last updated Dec 12, 2014
Key facts
- NPI
- 1407890692
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 175163 (KS)
- Legal business name
- SOUTHWEST MEDICAL CENTER
- Practice address
- 315 W 15TH St
Liberal, KS 67901-2455 - Phone
- (620) 624-1651
- Fax
- (620) 629-2472
- NPI assigned
- Jun 16, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTHWEST MEDICAL CENTER
Authorized official
- Name
- Mr. William Ermann
- Title
- Ceo/Administrator
- Phone
- (620) 629-6400
Owners & managing parties with NPI records 2
-
Dennis Knudsen, M.D.
-
Maria Lauralynn Noblejas, PSYD., LP
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 62
-
Muhammad Rizwan, MD
-
Kamran M Ali, MD
-
Christopher G Baalmann, M.D.
-
Timothy Daniel Barron, M.D.
-
Bruce W. Cook, C.R.N.A
-
Nathan Dobbs, MD
-
Timothy M Gronlie, M.D.
-
James Allen Homan, M.D.
-
Zaki G Ibrahim, MD
-
Firas I. Kawtharani, M.D.
-
Amisha Khicha, MD
-
Dennis Knudsen, M.D.
-
Lohitha Kolli, MD
-
Tiffany Landa, FNP-BC
-
Jose A. Maeda, MD
-
Lisa S May, MD
Affiliated clinicians 4
-
Muhammad Rizwan, MD
-
Tyler McMillan, M.D.
-
Abdul Sami Qazi, M.D.
-
Kenneth Son, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Southwest Medical Center SNF
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare
- Ownership
- Government - County
- Certified
- Jul 31, 1987
- Medicare certification status
- Active
- Certified beds
- 18 · 2.8 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Skilled nursing facility certification: CCN 175163
- Legal name
- SOUTHWEST MEDICAL CENTER
- Doing business as
- SOUTHWEST MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF (Medicare) only
- Participating since
- Jul 31, 1987
- Last certification
- Jun 12, 2024
- Beds
- 18
- Ownership / control type
- County
- Organization structure
- Other · Non-profit
- Enrollment address
- 315 W 15TH St
Liberal, KS 67901-2455 - Nursing home name
- SOUTHWEST MEDICAL CENTER SNF
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Keeley R Moree |
W-2 Managing Employee |
Jun 1, 2019 | |
| Ivanhoe Love |
Corporate Director |
Mar 18, 2018 | |
| Maria Lauralynn Noblejas |
Corporate Director |
Jul 1, 2021 | |
| Dennis L Knudsen |
Corporate Director |
Apr 1, 2022 | |
| Sandra Cain |
W-2 Managing Employee |
May 1, 2021 | |
| Jose Lara |
Corporate Director |
Apr 1, 2021 | |
| Mark Cowan |
Corporate Officer |
May 1, 2015 | |
| W-2 Managing Employee |
May 1, 2015 | ||
| John West |
Corporate Director | Apr 1, 2022 | |
| Amber Williams |
Corporate Director |
Sep 28, 2014 | |
| W-2 Managing Employee | Jul 1, 1997 | ||
| Tony McKee |
Corporate Director | Apr 1, 2022 | |
| Dennis Sander |
Corporate Director |
Apr 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040616000785 | KS | Part a Provider - Skilled Nursing Facility | 7517941651 | Practice locations: Liberal, KS |
| O20040805001105 | KS | Part B Supplier - Clinic/Group Practice | 7517941651 |
Receives reassigned benefits from 80 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Meade, KS; Liberal, KS; Johnson, KS; Hugoton, KS |
National Provider Directory
- Tax ID family
- Medical Center Anesth C
- Part of
- Medical Center Anesth C
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 175163 | KS | Yes |
Addresses
Primary practice location
315 W 15TH St
Liberal, KS 67901-2455
Mailing address
315 W 15TH Street
PO Box 1340
Liberal, KS 67905-1340
Phone (620) 624-1651
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118 | Other | KS | BCBS |
Other names
- Skilled Nursing Facility
Other providers in Liberal, KS
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
- Southwest Medical Center
All providers in Liberal, KS · Skilled Nursing Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.