Soco Nutrition, Llc | |
943 Short St, Canon City, CO 81212-4256 | |
(719) 426-1899 | |
Not Available |
Full Name | Soco Nutrition, Llc |
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Type | Facility |
Speciality | Dietitian, Registered |
Location | 943 Short St, Canon City, Colorado |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1336731371 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133V00000X | Dietitian, Registered | (* (Not Available)) | Primary |
Provider Name | Anna Kristin Payne |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1003205527 PECOS PAC ID: 4981019015 Enrollment ID: I20210223000346 |
Mailing Address | Practice Location Address |
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Soco Nutrition, Llc 943 Short St, Canon City, CO 81212-4256 Ph: (719) 426-1899 | Soco Nutrition, Llc 943 Short St, Canon City, CO 81212-4256 Ph: (719) 426-1899 |
Anna Kristin Payne, RDN Dietitian Medicare: Medicare Enrolled Practice Location: 943 Short St, Canon City, CO 81212 Phone: 719-426-1899 | |
Mr. Dave Earl Egerdahl, R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1338 Phay Ave, Canon City, CO 81212 Phone: 719-285-2025 Fax: 719-285-2277 | |
Miriam Loomis, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1338 Phay Ave, Canon City, CO 81212 Phone: 719-285-2548 | |
Mrs. Tenisha D Tavares, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1338 Phay Ave, Canon City, CO 81212 Phone: 719-285-2025 | |
Mrs. Christine Nicole Lewis, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1338 Phay Ave, Canon City, CO 81212 Phone: 719-285-2034 Fax: 719-285-2277 |