Healthcare Provider Details

I. General information

NPI: 1073867271
Provider Name (Legal Business Name): GLENWOOD MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N HORSESHOE TRL
SILT CO
81652-9832
US

IV. Provider business mailing address

1830 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4275
US

V. Phone/Fax

Practice location:
  • Phone: 970-876-5700
  • Fax: 970-876-0482
Mailing address:
  • Phone: 970-945-8503
  • Fax: 970-945-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48893
License Number StateCO

VIII. Authorized Official

Name: TIM BURNS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 970-945-8503