Healthcare Provider Details

I. General information

NPI: 1104922350
Provider Name (Legal Business Name): SOUTHWEST ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST STE 100
DURANGO CO
81301-7300
US

IV. Provider business mailing address

PO BOX 5581
DENVER CO
80217-5581
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-7977
  • Fax:
Mailing address:
  • Phone: 970-385-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN E BUSH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 970-385-7977