Provider Demographics
NPI:1992701106
Name:SOUTHWEST MEDICAL CENTER, INC
Entity type:Organization
Organization Name:SOUTHWEST MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-239-4700
Mailing Address - Street 1:119 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1027
Mailing Address - Country:US
Mailing Address - Phone:724-239-4700
Mailing Address - Fax:724-239-3262
Practice Address - Street 1:119 WILSON RD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1027
Practice Address - Country:US
Practice Address - Phone:724-239-4700
Practice Address - Fax:724-239-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD40975E207R00000X
PAMD39000L207R00000X
PAMD420995207R00000X
PAMD420170207R00000X
PAMA002213L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA051718OtherREGINA M HUDAK, PA-C