Healthcare Provider Details

I. General information

NPI: 1558309005
Provider Name (Legal Business Name): SURFACE CREEK FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 COTTONWOOD ST
DELTA CO
81416-4400
US

IV. Provider business mailing address

255 SW 8TH AVE
CEDAREDGE CO
81413-3902
US

V. Phone/Fax

Practice location:
  • Phone: 970-856-3146
  • Fax:
Mailing address:
  • Phone: 970-856-3146
  • Fax: 970-856-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateCO

VIII. Authorized Official

Name: DEBRA K JONES
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 970-856-3146