Healthcare Provider Details

I. General information

NPI: 1568406163
Provider Name (Legal Business Name): TELLURIDE MEDICAL CENTER-PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PACIFIC AVE
TELLURIDE CO
81435
US

IV. Provider business mailing address

PO BOX 1229
TELLURIDE CO
81435-1229
US

V. Phone/Fax

Practice location:
  • Phone: 970-728-3848
  • Fax: 970-728-3404
Mailing address:
  • Phone: 970-728-3848
  • Fax: 970-728-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0393
License Number StateCO

VIII. Authorized Official

Name: MARCIA T JENNINGS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 828-260-0476