Healthcare Provider Details

I. General information

NPI: 1053308858
Provider Name (Legal Business Name): FLORENCE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 5TH ST
FLORENCE CO
81226-1126
US

IV. Provider business mailing address

501 W 5TH ST
FLORENCE CO
81226-1126
US

V. Phone/Fax

Practice location:
  • Phone: 719-784-4816
  • Fax: 719-784-6014
Mailing address:
  • Phone: 719-784-4816
  • Fax: 719-784-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8414456
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH T. MCGARRY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 719-784-4816