Provider Demographics
NPI:1003530791
Name:SOUTHWEST COLORADO MENTAL HEALTH CENTER INC DBA AXIS HEALTH SYSTEM
Entity Type:Organization
Organization Name:SOUTHWEST COLORADO MENTAL HEALTH CENTER INC DBA AXIS HEALTH SYSTEM
Other - Org Name:AXIS HEALTH PHARMACY- CORTEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-446-2543
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-1328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 E EMPIRE ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2802
Practice Address - Country:US
Practice Address - Phone:970-565-7946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST COLORADO MENTAL HEALTH CENTER INC DBA AXIS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-27
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy