Provider Demographics
NPI:1487779922
Name:JEAN-MICHEL, HASSAN, MD SOUTHWEST CLINIC INC
Entity type:Organization
Organization Name:JEAN-MICHEL, HASSAN, MD SOUTHWEST CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MICHEL
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-626-4368
Mailing Address - Street 1:555 W 15TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2468
Mailing Address - Country:US
Mailing Address - Phone:620-626-4368
Mailing Address - Fax:620-626-7370
Practice Address - Street 1:555 W 15TH ST STE D
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2468
Practice Address - Country:US
Practice Address - Phone:620-626-4368
Practice Address - Fax:620-626-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431410207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111347OtherMEDICARE
KS111347OtherBCBSKS
KS111347OtherMEDICARE