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General NPI Number Information
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NPI Number | 1053603993
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Entity Type | Individual
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Provider Name | CLINT B PITCHFORTH CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 1501 E 3RD ST
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City | DELTA
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State | CO
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Zip | 81416-2815
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Country | US
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Telephone | 970-874-7681
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Fax | 970-874-6400
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Provider Business Mailing Address
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Address Line | PO BOX 10100
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City | DELTA
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State | CO
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Zip | 81416-0008
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Country | US
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Telephone | 970-874-7681
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Fax | 970-874-6400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA-01147
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 250160
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 100093
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License Number State | CO
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