Healthcare Provider Details

I. General information

NPI: 1073869467
Provider Name (Legal Business Name): TOTAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST SUITE 160
DURANGO CO
81301-7306
US

IV. Provider business mailing address

PO BOX 802793
KANSAS CITY MO
64180-2793
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-9850
  • Fax: 970-385-9854
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA J SKINNER
Title or Position: OMA ADMINISTRATOR
Credential:
Phone: 303-673-7175