Healthcare Provider Details

I. General information

NPI: 1881684785
Provider Name (Legal Business Name): CATHY MCCURDY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHICO CT
MONTE VISTA CO
81144-1065
US

IV. Provider business mailing address

106 BLANCA AVE
ALAMOSA CO
81101-2340
US

V. Phone/Fax

Practice location:
  • Phone: 719-852-9400
  • Fax: 719-852-9311
Mailing address:
  • Phone: 719-589-2511
  • Fax: 719-587-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number87
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: