Provider Demographics
NPI:1073500419
Name:SOUTHWESTERN REGIONAL MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SOUTHWESTERN REGIONAL MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-286-5793
Mailing Address - Street 1:5900 BROKEN SOUND PKWY NW
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2797
Mailing Address - Country:US
Mailing Address - Phone:918-286-5000
Mailing Address - Fax:918-286-5081
Practice Address - Street 1:10109 E 79TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-286-5000
Practice Address - Fax:918-286-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK370190Medicare ID - Type Unspecified