Provider Demographics
NPI:1083784060
Name:SOUTHWEST INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:SOUTHWEST INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-564-8730
Mailing Address - Street 1:111 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3340
Mailing Address - Country:US
Mailing Address - Phone:970-564-8730
Mailing Address - Fax:
Practice Address - Street 1:111 N PARK ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3340
Practice Address - Country:US
Practice Address - Phone:970-564-8730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98950886Medicaid
CO18627269Medicaid
AZ798770Medicaid
CO18627269Medicaid
CO=========001OtherROCKY MOUNTAIN HEALTHPLAN
UT=========009Medicaid
NM98950886Medicaid