Healthcare Provider Details

I. General information

NPI: 1922144237
Provider Name (Legal Business Name): COLUMBINE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21454 MOUNT FALCON ROAD
INDIAN HILLS CO
80454-0396
US

IV. Provider business mailing address

PO BOX 396
INDIAN HILLS CO
80454-0396
US

V. Phone/Fax

Practice location:
  • Phone: 303-918-1222
  • Fax:
Mailing address:
  • Phone: 303-918-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBRA S SALTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-918-1222