Healthcare Provider Details

I. General information

NPI: 1760795330
Provider Name (Legal Business Name): MERCY REGIONAL MEDICAL CENTER OF DURANGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S RIO GRANDE AVE
AZTEC NM
87410-2260
US

IV. Provider business mailing address

1010 THREE SPRINGS BLVD
DURANGO CO
81301-8296
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-5640
  • Fax: 505-334-5649
Mailing address:
  • Phone: 970-247-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number1628.1
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1628.1
License Number StateNM

VIII. Authorized Official

Name: KIRK A DIGNUM
Title or Position: CEO/PRESIDENT
Credential:
Phone: 970-247-4311