Provider Demographics
NPI:1104922350
Name:SOUTHWEST ONCOLOGY PC
Entity type:Organization
Organization Name:SOUTHWEST ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-385-7977
Mailing Address - Street 1:PO BOX 5581
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5581
Mailing Address - Country:US
Mailing Address - Phone:970-385-7977
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO ST STE 100
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-385-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ849888Medicaid
COSO65319OtherBLUE CROSS BLUE SHIELD
CO205165100OtherDPT OF LABOR WORKCOMP
NMK6916Medicaid
CO020277599OtherENERGY EMPLOYEE OCCUP
CO02721287Medicaid
CO205165100OtherDPT OF LABOR WORKCOMP
COSO65319OtherBLUE CROSS BLUE SHIELD
NMK6916Medicaid
CO02721287Medicaid