MEDICARE: TELLURIDE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center	0393	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508807694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELLURIDE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1229
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-1229
Country	:	US
Telephone Number	:	970-369-2311
Fax Number	:	970-728-3404

Provider Business Practice Location Address
First Line	:	500 W PACIFIC AVE
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435
Country	:	US
Telephone Number	:	970-369-2311
Fax Number	:	970-728-3404

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	PAM MCCREEDY
Credential	:
Telephone Number	:	970-369-2311

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/22/2020

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Directions to “TELLURIDE MEDICAL CENTER ” Practice Location

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