Healthcare Provider Details

I. General information

NPI: 1386678159
Provider Name (Legal Business Name): AMBER C REISS-HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER C REISS-HOLT MD

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 TALISMAN DR STE 3
PAGOSA SPRINGS CO
81147-9377
US

IV. Provider business mailing address

27 TALISMAN DR STE 3
PAGOSA SPRINGS CO
81147-9377
US

V. Phone/Fax

Practice location:
  • Phone: 970-372-0456
  • Fax:
Mailing address:
  • Phone: 970-372-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number49984
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number49984
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number49984
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD2023-1112
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number49984
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA83063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: