Healthcare Provider Details

I. General information

NPI: 1376317644
Provider Name (Legal Business Name): RURAL PHYSICIANS GROUP, PANNU-PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E JOHNSON ST
HOLYOKE CO
80734-1854
US

IV. Provider business mailing address

5575 DTC PKWY STE 225
GREENWOOD VILLAGE CO
80111-3073
US

V. Phone/Fax

Practice location:
  • Phone: 303-390-1924
  • Fax: 866-368-6349
Mailing address:
  • Phone: 303-390-1926
  • Fax: 866-368-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: SUKHBIR S PANNU
Title or Position: OWNER
Credential:
Phone: 702-933-3266