Provider Demographics
NPI:1801829072
Name:SOUTHERN COLORADO EMERGENCY SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHERN COLORADO EMERGENCY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-538-8100
Mailing Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD STE C
Mailing Address - Street 2:PMB 406
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4570
Mailing Address - Country:US
Mailing Address - Phone:719-538-8100
Mailing Address - Fax:719-538-8003
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:719-560-5656
Practice Address - Fax:719-560-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2370237OtherAETNA
CO17229260Medicaid
COSO641446OtherBLUE CROSS
COCH4783OtherRAILROAD MEDICARE
CO2370237OtherAETNA
COCH4783OtherRAILROAD MEDICARE