MEDICARE: ANN THEINE PA-C

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	363AS0400X	Surgical Physician Assistant	PA.0002064	CO

General Provider Information

NPI Number	:	1821049750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN THEINE PA-C

Provider Business Mailing Address
First Line	:	1 MERCADO ST
Second Line	:	STE 202
City	:	DURANGO
State	:	CO
Zip	:	81301-7300
Country	:	US
Telephone Number	:	970-247-5362
Fax Number	:	970-259-6045

Provider Business Practice Location Address
First Line	:	1 MERCADO ST
Second Line	:	STE 202
City	:	DURANGO
State	:	CO
Zip	:	81301-7300
Country	:	US
Telephone Number	:	970-247-5362
Fax Number	:	970-259-6045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/09/2026

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Directions to “ ANN THEINE PA-C” Practice Location

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