Healthcare Provider Details

I. General information

NPI: 1912164039
Provider Name (Legal Business Name): SOUTHWEST NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 N 95TH AVE STE 132
PHOENIX AZ
85037-4445
US

IV. Provider business mailing address

2700 N CENTRAL AVE SUITE 1050
PHOENIX AZ
85004-1133
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-6950
  • Fax: 623-932-7995
Mailing address:
  • Phone: 602-266-8402
  • Fax: 602-264-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberOTC6612
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTC6612
License Number StateAZ

VIII. Authorized Official

Name: MS. AMY B. HENNING
Title or Position: CEO
Credential:
Phone: 602-285-4340