Provider Demographics
NPI:1932475894
Name:SOUTHWEST HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SOUTHWEST HEALTH SYSTEM, INC.
Other - Org Name:SOUTHWEST MEMORIAL PHYSICIANS
Other - Org Type:Doing Business As
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 ROAD
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:970-564-2152
Mailing Address - Fax:970-564-2155
Practice Address - Street 1:1311 N MILDRED ROAD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2231
Practice Address - Country:US
Practice Address - Phone:970-565-0712
Practice Address - Fax:970-565-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCG4004Medicare PIN