Provider Demographics
NPI: | 1649241571 |
---|---|
Name: | SOUTHWEST HEALTH SYSTEM INC |
Entity Type: | Organization |
Organization Name: | SOUTHWEST HEALTH SYSTEM INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF HUMAN RESOURCES OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TRAVIS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PARKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 970-564-2163 |
Mailing Address - Street 1: | 1311 N MILDRED RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CORTEZ |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81321-2231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-565-6666 |
Mailing Address - Fax: | 970-564-2149 |
Practice Address - Street 1: | 1311 N MILDRED RD |
Practice Address - Street 2: | |
Practice Address - City: | CORTEZ |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81321 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-565-6666 |
Practice Address - Fax: | 970-564-2149 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-01-30 |
Last Update Date: | 2023-06-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207L00000X, 207P00000X, 207RS0012X, 207V00000X, 207W00000X, 207X00000X, 2081P2900X, 2085R0202X, 208600000X, 208M00000X, 213ES0103X, 275N00000X, 333300000X | ||
CO | 11206 | 282NC0060X |
CO | 011206 | 3416L0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 275N00000X | Hospital Units | Medicare Defined Swing Bed Unit | Group - Multi-Specialty | |
No | 333300000X | Suppliers | Emergency Response System Companies | ||
No | 3416L0300X | Transportation Services | Ambulance | Land Transport | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 05002050 | Medicaid | |
CO | 04020020 | Medicaid | |
CO | 06600183 | Medicaid | |
CO | 04020020 | Medicaid | |
CO | 061327 | Medicare Oscar/Certification | |
CO | 04143012 | Medicaid | |
CO | 04020020 | Medicaid |