| Heritage Internal Medicine, Pc | |
|
1925 E Orman Ave Suite A535 Pueblo CO 81004-3537 | |
| (719) 564-0450 | |
| (719) 564-1659 |
| Full Name | Heritage Internal Medicine, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1925 E Orman Ave, Pueblo, Colorado |
| Authorized Official Name and Position | James R Stjernholm (PRESIDENT) |
| Authorized Official Contact | 7195640450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Internal Medicine, Pc 1925 E Orman Ave Suite A535 Pueblo CO 81004-3537 Ph: (719) 564-0450 | Heritage Internal Medicine, Pc 1925 E Orman Ave Suite A535 Pueblo CO 81004-3537 Ph: (719) 564-0450 |
| NPI Number | 1669681581 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 04/29/2008 |
| Medicare PECOS PAC ID | 9032192463 |
|---|---|
| Medicare Enrollment ID | O20040608001020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669681581 | NPI | - | NPPES |
| CN4621 | Other | CO | RAILROAD MEDICARE |
| 04021622 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | George Franklyn Birks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659338499 PECOS PAC ID: 0648215590 Enrollment ID: I20050622000452 |
| Provider Name | Linda D Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902906548 PECOS PAC ID: 4183631815 Enrollment ID: I20060321000292 |
| Provider Name | Thomas K Gaide |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447301791 PECOS PAC ID: 0749382893 Enrollment ID: I20070221000180 |
| Provider Name | Melchor Sipalay |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356390074 PECOS PAC ID: 5991692287 Enrollment ID: I20090203000350 |
| Provider Name | James Richard Stjernholm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275545469 PECOS PAC ID: 0941382444 Enrollment ID: I20110127000401 |
| Provider Name | Stephanie Katherine Lucas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548647795 PECOS PAC ID: 4385935949 Enrollment ID: I20180904002225 |
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