Healthcare Provider Details

I. General information

NPI: 1205078474
Provider Name (Legal Business Name): VANCE KEITH PURDUE SR. RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 PITCHFORK RD
MONTROSE CO
81401-5994
US

IV. Provider business mailing address

1312 PITCHFORK RD
MONTROSE CO
81401-5994
US

V. Phone/Fax

Practice location:
  • Phone: 970-765-5525
  • Fax:
Mailing address:
  • Phone: 970-765-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number959
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: