Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1413 N Mildred Rd, Cortez, Colorado |
Authorized Official Name and Position | Travis Parker (CHIEF HUMAN RESOURCES OFFICER) |
Authorized Official Contact | 9705642163 |
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) 564-2152 | 1413 N Mildred Rd Cortez CO 81321 Ph: (970) 564-1037 |
NPI Number | 1083917868 |
---|---|
Provider Enumeration Date | 12/16/2010 |
Last Update Date | 06/20/2023 |
Medicare PECOS PAC ID | 5890699326 |
---|---|
Medicare Enrollment ID | O20120328000426 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083917868 | NPI | - | NPPES |
26424371 | Medicaid | CO |
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 | |