Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 418 S Sligo St, Cortez, Colorado |
Authorized Official Name and Position | Anthony Sudduth (CEO) |
Authorized Official Contact | 9705642150 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1311 N Mildred Rd Cortez CO 81321-2231 Ph: (970) 564-2258 | 418 S Sligo St Cortez CO 81321 Ph: (970) 564-4855 |
NPI Number | 1609274661 |
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Provider Enumeration Date | 12/08/2014 |
Last Update Date | 06/11/2019 |
Medicare PECOS PAC ID | 5890699326 |
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Medicare Enrollment ID | O20151014002450 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609274661 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (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 | |