Healthcare Provider Details

I. General information

NPI: 1184870669
Provider Name (Legal Business Name): JOANNE I. HUNTINGTON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SIXTH STREET UNIT A
CRESTED BUTTE CO
81224
US

IV. Provider business mailing address

PO BOX 1668
CRESTED BUTTE CO
81224-1668
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-7193
  • Fax: 866-245-3787
Mailing address:
  • Phone: 970-349-7193
  • Fax: 866-245-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number45619
License Number StateCO

VIII. Authorized Official

Name: DR. JOANNE I HUNTINGTON
Title or Position: PRESIDENT
Credential: MD
Phone: 970-349-7193