Provider Demographics
NPI:1285638130
Name:SOUTHWEST CHILDRENS CENTER, PA
Entity type:Organization
Organization Name:SOUTHWEST CHILDRENS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANNING
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-8687
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:STE 310
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-614-8687
Mailing Address - Fax:210-614-7529
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:STE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6044
Practice Address - Country:US
Practice Address - Phone:210-614-8687
Practice Address - Fax:210-614-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BF20OtherBLUE CROSS GROUP NUMBER
TX00BF20OtherBLUE CROSS GROUP NUMBER