Healthcare Provider Details

I. General information

NPI: 1821279274
Provider Name (Legal Business Name): HIGH MESA FAMILY MEDCINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 N DOLORES RD SUITE C
CORTEZ CO
81321-8924
US

IV. Provider business mailing address

1423 E MAIN ST #404
CORTEZ CO
81321-2931
US

V. Phone/Fax

Practice location:
  • Phone: 970-564-8177
  • Fax:
Mailing address:
  • Phone: 970-560-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39495
License Number StateCO

VIII. Authorized Official

Name: DR. MARCUS T HIGI
Title or Position: OWNER
Credential: MD
Phone: 970-560-1389