Provider Demographics
NPI:1003155185
Name:SOUTHWEST HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SOUTHWEST HEALTH SYSTEM, INC.
Other - Org Name:RED ROCK PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-564-2150
Mailing Address - Street 1:1311 N MILDRED ROAD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321
Mailing Address - Country:US
Mailing Address - Phone:970-564-2152
Mailing Address - Fax:970-564-2155
Practice Address - Street 1:1280 N MILDRED RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321
Practice Address - Country:US
Practice Address - Phone:970-565-8336
Practice Address - Fax:970-565-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85375047Medicaid