NPIMap

Organization Active NPI

Southwest Healthcare Services

Doing business as Southwest Medical Clinic RHC

  • Rural Health Clinic/Center
  • Bowman, ND
National Provider Identifier
1891893624
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHWEST HEALTHCARE SERVICES
Doing business as
Southwest Medical Clinic RHC
Practice address
802 2ND St NW
Bowman, ND 58623-4483
Phone
(701) 523-5555
Fax
(701) 523-7107
NPI assigned
Sep 20, 2006
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Lisa Knopp, CLINIC
Title
Office Manger
Phone
(701) 523-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X ND Primary

Addresses

Primary practice location

802 2ND St NW
Bowman, ND 58623-4483

Mailing address

802 2ND St NW Ste 1
Bowman, ND 58623-4469
Phone (701) 523-5555

Other identifiers 2

IdentifierTypeStateIssuer
05145MedicaidND
09274OtherNDRURAL HEALTH CLINIC

Other names 1

  • SOUTHWEST MEDICAL CLINIC RHC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060330000547 ND Part A Provider - Rural Health Clinic 3173512704 Practice locations: Bowman, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891893624. Details of each certification follow.

Rural health clinic certification: CCN 353406

Legal name
SOUTHWESTHEALTHCARE SERVICES
Doing business as
SOUTHWEST MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 1993
Last certification
Sep 23, 2025
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2001 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 2001 in ND
Enrollment address
802 2ND St NW
Ste 1
Bowman, ND 58623-4469
Related CCNs
351313

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Southwest Healthcare Serv7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dennis Goebel Individual Corporate Officer Oct 15, 2021
Corporate DirectorCeo Oct 15, 2021
Tina Marmon Individual W-2 Managing EmployeeClinic Manager Nov 1, 2011

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1891893624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 2ND ST NW STE 1",
            "city": "BOWMAN",
            "state": "ND",
            "postal_code": "586234469",
            "telephone_number": "701-523-5555",
            "fax_number": "701-523-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 2ND ST NW",
            "city": "BOWMAN",
            "state": "ND",
            "postal_code": "586234483",
            "telephone_number": "701-523-5555",
            "fax_number": "701-523-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "KNOPP",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "701-523-5555",
        "authorized_official_credential": "CLINIC"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05145",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH CLINIC",
            "identifier": "09274",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHWEST MEDICAL CLINIC RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowman, ND

Sources for this page

Verify at the official NPI Registry.