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General NPI Number Information
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NPI Number | 1356374300
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Entity Type | Organization
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Legal Business Name | SALIDA FAMILY MEDICINE
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 320 E 1ST ST
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City | SALIDA
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State | CO
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Zip | 81201
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Country | US
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Telephone | 719-539-3612
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Fax | 719-539-3028
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Provider Business Mailing Address
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Address Line | 320 E 1ST ST
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City | SALIDA
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State | CO
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Zip | 81201-2802
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Country | US
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Telephone | 719-539-3612
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Fax | 719-539-3028
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Authorized Official
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Title or Position | PRACTICE ADMINISTATOR
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Name | TRUDY L FOGG
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Credential |
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Telephone | 719-539-3583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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