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General NPI Number Information
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NPI Number | 1235310285
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Entity Type | Organization
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Legal Business Name | STONEY MESA FAMILY PRACTICE INC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 1722 HILLCREST DR
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City | DELTA
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State | CO
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Zip | 81416-2810
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Country | US
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Telephone | 970-874-5061
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Fax | 970-874-5074
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Provider Business Mailing Address
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Address Line | PO BOX 1129
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City | DELTA
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State | CO
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Zip | 81416-1129
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Country | US
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Telephone | 970-874-2470
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Fax | 970-874-2475
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MICHELLE PURVIS
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Credential | MD
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Telephone | 970-874-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39111
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License Number State | CO
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