Full Name | |
---|---|
Speciality | Clinic/center |
Location | 118 N Chestnut, Cortez, Colorado |
Authorized Official Name and Position | Anthony Sudduth (CEO) |
Authorized Official Contact | 9705642150 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1311 N Mildred Rd Cortez CO 81321-2231 Ph: (970) 564-2152 | 118 N Chestnut Cortez CO 81321 Ph: (970) 564-9777 |
NPI Number | 1104823939 |
---|---|
Provider Enumeration Date | 07/07/2005 |
Last Update Date | 06/08/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104823939 | NPI | - | NPPES |
04020020 | Medicaid | CO | |
05002050 | Medicaid | CO | |
04143012 | Medicaid | CO | |
06600183 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 19961032821 (Colorado) | Primary |
282NC0060X | General Acute Care Hospital - Critical Access | 11206 (Colorado) | Secondary |
Southwest Internal Medicine Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 111 N Park St, Cortez, CO 81321 Phone: 970-564-8730 | |