Healthcare Provider Details

I. General information

NPI: 1225032907
Provider Name (Legal Business Name): LIMON DOCTORS COMMITTEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 6TH ST
HUGO CO
80828-0308
US

IV. Provider business mailing address

PO BOX 1120
LIMON CO
80828-1120
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-2367
  • Fax: 719-775-2365
Mailing address:
  • Phone: 719-775-2367
  • Fax: 719-775-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0675
License Number StateCO

VIII. Authorized Official

Name: DONNA CALABRESE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-775-2367