Provider Demographics
NPI:1386959245
Name:SOUTHWEST FAMILY CARE ALLIANCE
Entity type:Organization
Organization Name:SOUTHWEST FAMILY CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-647-4729
Mailing Address - Street 1:28526 US HWY 14
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-5114
Mailing Address - Country:US
Mailing Address - Phone:608-647-4729
Mailing Address - Fax:608-649-4728
Practice Address - Street 1:28526 US HWY 14
Practice Address - Street 2:
Practice Address - City:LONE ROCK
Practice Address - State:WI
Practice Address - Zip Code:53556-5114
Practice Address - Country:US
Practice Address - Phone:608-647-4729
Practice Address - Fax:608-649-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization