Provider Demographics
NPI:1538497912
Name:SOUTHWEST NETWORK
Entity Type:Organization
Organization Name:SOUTHWEST NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-285-4340
Mailing Address - Street 1:2700 N CENTRAL AVE
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1133
Mailing Address - Country:US
Mailing Address - Phone:602-266-8402
Mailing Address - Fax:602-264-0887
Practice Address - Street 1:460 N MESA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5973
Practice Address - Country:US
Practice Address - Phone:480-838-5550
Practice Address - Fax:480-756-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6259251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ127516OtherMEDICARE PTAN
AZ515610Medicaid