Healthcare Provider Details

I. General information

NPI: 1942259973
Provider Name (Legal Business Name): WESTERN VALLEY FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N PLUM ST
FRUITA CO
81521-2100
US

IV. Provider business mailing address

281 N PLUM ST
FRUITA CO
81521-2100
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-9894
  • Fax: 970-858-1331
Mailing address:
  • Phone: 970-858-9894
  • Fax: 970-858-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22481
License Number StateCO

VIII. Authorized Official

Name: DR. KURTIS HOLMES
Title or Position: PRESIDENT
Credential: D.O.
Phone: 970-858-9894