Healthcare Provider Details

I. General information

NPI: 1952414260
Provider Name (Legal Business Name): DOLORES MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CENTRAL
DOLORES CO
81323-0908
US

IV. Provider business mailing address

PO BOX 908
DOLORES CO
81323-0908
US

V. Phone/Fax

Practice location:
  • Phone: 970-882-7221
  • Fax: 970-882-4243
Mailing address:
  • Phone: 970-882-7221
  • Fax: 970-882-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number32885
License Number StateCO

VIII. Authorized Official

Name: DR. ALLAN SCOTT BURNSIDE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 970-882-7221