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General NPI Number Information
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NPI Number | 1104922350
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Entity Type | Organization
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Legal Business Name | SOUTHWEST ONCOLOGY PC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1 MERCADO ST STE 100
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City | DURANGO
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State | CO
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Zip | 81301-7300
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Country | US
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Telephone | 970-385-7977
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5581
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City | DENVER
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State | CO
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Zip | 80217-5581
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Country | US
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Telephone | 970-385-7977
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN E BUSH
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Credential | M.D.
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Telephone | 970-385-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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