Healthcare Provider Details

I. General information

NPI: 1568495653
Provider Name (Legal Business Name): SOUTHWEST EMERGENCY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 THREE SPRINGS BLVD EMERGENCY DEPARTMENT
DURANGO CO
81301-8296
US

IV. Provider business mailing address

PO BOX 17752
DENVER CO
80217-0752
US

V. Phone/Fax

Practice location:
  • Phone: 970-764-2100
  • Fax:
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN GRAHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 970-247-4311