Healthcare Provider Details

I. General information

NPI: 1992609010
Provider Name (Legal Business Name): MOUNTAIN MEDICAL AND PSYCHIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 BREEZE ST
CRAIG CO
81625-2602
US

IV. Provider business mailing address

538 BREEZE ST
CRAIG CO
81625-2602
US

V. Phone/Fax

Practice location:
  • Phone: 970-761-9211
  • Fax:
Mailing address:
  • Phone: 970-761-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAYLOR THRAILKILL
Title or Position: CREDENTIALING
Credential:
Phone: 970-216-2396