Healthcare Provider Details

I. General information

NPI: 1720286321
Provider Name (Legal Business Name): RANGELY FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S WHITE AVE
RANGELY CO
81648-2109
US

IV. Provider business mailing address

509 S WHITE AVE
RANGELY CO
81648-2109
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-2237
  • Fax:
Mailing address:
  • Phone: 970-675-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON MCCORMICK
Title or Position: CEO
Credential:
Phone: 970-675-5011