Healthcare Provider Details

I. General information

NPI: 1588838023
Provider Name (Legal Business Name): CRESTED BUTTE MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SNOWMASS RD SUITE 1
MT. CRESTED BUTTE CO
81225
US

IV. Provider business mailing address

PO BOX 1850
CRESTED BUTTE CO
81224-1850
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-0321
  • Fax:
Mailing address:
  • Phone: 970-349-0321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number30833
License Number StateCO

VIII. Authorized Official

Name: PATTI KAECH
Title or Position: MANAGER
Credential:
Phone: 970-349-0321