Healthcare Provider Details

I. General information

NPI: 1124070727
Provider Name (Legal Business Name): MERCY REGIONAL MEDICAL CENTER OF DURANGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 THREE SPRINGS BLVD
DURANGO CO
81301-8296
US

IV. Provider business mailing address

1010 THREE SPRINGS BLVD
DURANGO CO
81301-8296
US

V. Phone/Fax

Practice location:
  • Phone: 970-764-3775
  • Fax:
Mailing address:
  • Phone: 970-247-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRK A DIGNUM
Title or Position: CEO PRESIDENT
Credential:
Phone: 970-247-4311