NPIMap

Organization Active NPI

Southwest Colorado Mental Health Center, Inc

Doing business as Axis Health System

  • Federally Qualified Health Center (FQHC)
  • Cortez, CO
National Provider Identifier
1447630504
Registry record updated Oct 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC
Doing business as
Axis Health System
Practice address
691 E Empire St
Cortez, CO 81321-2802
Phone
(970) 565-7946
NPI assigned
Jun 4, 2015
Last updated
Oct 23, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHWEST COLORADO MENTAL HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Lacov
Title
Cfo
Phone
(970) 335-2342

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

691 E Empire St
Cortez, CO 81321-2802

Mailing address

PO Box 1328
Durango, CO 81302-1328
Phone (970) 335-2342

Other names 2

  • Axis Health System Doing business as
  • Cortez Integrated Healthcare Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326001177 CO Part B Supplier - Clinic/Group Practice 9133011802 Receives reassigned benefits from 95 practitioners
46 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gunnison, CO; Montrose, CO; Norwood, CO; Pagosa Springs, CO; Telluride, CO; Crested Butte, CO; Durango, CO; Dove Creek, CO…
O20151021002151 CO Part A Provider - Federally Qualified Health Center (FQHC) 9133011802 Practice locations: Cortez, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447630504. Details of each certification follow.

Federally qualified health center certification: CCN 061956

Legal name
SOUTHWEST COLORADO MENTAL HEALTH CENTER INC
Doing business as
AXIS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2015
Last certification
Oct 20, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1960 in CO
Enrollment address
691 E Empire St
Cortez, CO 81321-2802

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory
Part of
Pinon Mesa Guidance Cen

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pamela Wise Romero Individual Corporate OfficerChief Medical Officer Jul 22, 2002 50%
Operational/Managerial ControlChief Medical Officer Jul 22, 2002 50%
John Albright Individual Corporate DirectorBoard of Directors Feb 1, 2000
Robert Yearout Individual Corporate DirectorBoard of Directors Nov 1, 2016
Charles R Forth Individual Corporate DirectorBoard of Directors Oct 15, 2014
Frances Perrin Individual Corporate DirectorBoard of Directors Dec 1, 2019
William August Westerman Individual Corporate DirectorBoard of Directors Nov 20, 2019
Stephanie K Allred Individual Operational/Managerial ControlSenior Clinical Director Jan 1, 2010
Paul Nazaryk Individual Corporate DirectorBoard of Directors Dec 1, 2016
Alex Durham Individual Corporate DirectorBoard of Directors Apr 15, 2022
Marissa Talamante Individual Corporate DirectorBoard of Directors May 1, 2019
Makaila Boschert Individual W-2 Managing EmployeeReimbursement Supervisor Mar 31, 2020
Alex Conrad Individual Corporate OfficerChief Financial Officer Jun 12, 2020
Shelly Burke Individual Corporate OfficerChief Operating Officer Jul 22, 2002
Operational/Managerial ControlChief Operating Officer Jul 22, 2002
Amanda Miller Individual Corporate DirectorBoard of Directors Apr 1, 2016
Karen Sheek Individual Corporate DirectorBoard of Directors Aug 1, 2015
Robert Juskevich Individual Corporate DirectorBoard of Directors Jul 16, 2014
Rob McNutt Individual Corporate DirectorBoard of Directors Apr 1, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Axis Health SystemPagosa Springs, CO, CCN 061028 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemDurango, CO, CCN 061074 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemGunnison, CO, CCN 061073 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemTelluride, CO, CCN 061082 Federally qualified health center Operational/Managerial Control Oct 7, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792713600000",
    "number": "1447630504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1328",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813021328",
            "telephone_number": "970-335-2342",
            "fax_number": "970-335-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "691 E EMPIRE ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212802",
            "telephone_number": "970-565-7946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC",
        "enumeration_date": "2015-06-04",
        "last_updated": "2026-10-23",
        "certification_date": "2026-10-23",
        "status": "A",
        "authorized_official_last_name": "LACOV",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-335-2342"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Axis Health System",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cortez Integrated Healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cortez, CO

Sources for this page

Verify at the official NPI Registry.