Healthcare Provider Details

I. General information

NPI: 1558397281
Provider Name (Legal Business Name): HIGH PLAINS TOTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E ORMAN AVE STE A 235
PUEBLO CO
81004-3537
US

IV. Provider business mailing address

1925 E ORMAN AVE STE A 235
PUEBLO CO
81004-3537
US

V. Phone/Fax

Practice location:
  • Phone: 719-565-0200
  • Fax: 719-565-0999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number38639
License Number StateCO

VIII. Authorized Official

Name: VAUGHAN CIPPERLY
Title or Position: OWNER
Credential:
Phone: 719-565-0200