Healthcare Provider Details

I. General information

NPI: 1346245750
Provider Name (Legal Business Name): PLAINS MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55981 E. COLFAX AVE
STRASBURG CO
80136-1219
US

IV. Provider business mailing address

PO BOX 1120
LIMON CO
80828-1120
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-2367
  • Fax: 719-775-2365
Mailing address:
  • Phone: 719-775-2367
  • Fax: 719-775-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1188
License Number StateCO

VIII. Authorized Official

Name: ZETTIE PAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-775-2367