Provider Demographics
NPI:1548273337
Name:SOUTHWEST HEALTH CORPORATION
Entity type:Organization
Organization Name:SOUTHWEST HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-851-4505
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0910
Mailing Address - Country:US
Mailing Address - Phone:787-851-2025
Mailing Address - Fax:787-254-0235
Practice Address - Street 1:108 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4060
Practice Address - Country:US
Practice Address - Phone:787-851-2025
Practice Address - Fax:787-254-0235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST HEALTH CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-14
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR380291U00000X
PR13261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20085Medicare PIN