Provider Demographics
NPI:1487623146
Name:SOUTHWEST COLORADO SURGICAL CENTER LLC
Entity type:Organization
Organization Name:SOUTHWEST COLORADO SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAINER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:970-565-1400
Mailing Address - Street 1:20 S BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3744
Mailing Address - Country:US
Mailing Address - Phone:970-565-1400
Mailing Address - Fax:970-564-1655
Practice Address - Street 1:20 S BEECH ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3744
Practice Address - Country:US
Practice Address - Phone:970-565-1400
Practice Address - Fax:970-564-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
495758Medicare ID - Type Unspecified