1497279236 NPI number — SOUTHWEST HEALTH SYSTEM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497279236 NPI number — SOUTHWEST HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST HEALTH SYSTEM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHWEST MEMORIAL DOLORES RIVER CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497279236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1311 N MILDRED RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTEZ
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81321-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-564-2152
Provider Business Mailing Address Fax Number:
970-564-2155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOLORES
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-564-2152
Provider Business Practice Location Address Fax Number:
970-564-2155
Provider Enumeration Date:
08/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SUDDUTH
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
970-564-2150

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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