Healthcare Provider Details

I. General information

NPI: 1003155185
Provider Name (Legal Business Name): SOUTHWEST HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 N MILDRED RD SUITE 1
CORTEZ CO
81321
US

IV. Provider business mailing address

1311 N MILDRED ROAD
CORTEZ CO
81321
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-8336
  • Fax: 970-565-3134
Mailing address:
  • Phone: 970-564-2152
  • Fax: 970-564-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM KENT ROGERS
Title or Position: CEO
Credential:
Phone: 970-564-2150