Full Name | |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 1413 N Mildred Rd, 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 Road Cortez CO 81321-2231 Ph: (970) 564-2152 | 1413 N Mildred Rd Cortez CO 81321 Ph: (970) 565-4436 |
NPI Number | 1285614941 |
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Provider Enumeration Date | 01/19/2006 |
Last Update Date | 06/06/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285614941 | NPI | - | NPPES |
04021333 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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 | |