Healthcare Provider Details

I. General information

NPI: 1104823939
Provider Name (Legal Business Name): SOUTHWEST HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N CHESTNUT
CORTEZ CO
81321
US

IV. Provider business mailing address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 970-564-9777
  • Fax: 970-564-8833
Mailing address:
  • Phone: 970-564-2152
  • Fax: 970-564-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number19961032821
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number11206
License Number StateCO

VIII. Authorized Official

Name: MR. ANTHONY SUDDUTH
Title or Position: CEO
Credential:
Phone: 970-564-2150