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General NPI Number Information
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NPI Number | 1558309005
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Entity Type | Organization
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Legal Business Name | SURFACE CREEK FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 233 COTTONWOOD ST
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City | DELTA
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State | CO
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Zip | 81416-4400
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Country | US
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Telephone | 970-856-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 255 SW 8TH AVE
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City | CEDAREDGE
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State | CO
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Zip | 81413-3902
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Country | US
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Telephone | 970-856-3146
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Fax | 970-856-4385
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DEBRA K JONES
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Credential |
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Telephone | 970-856-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | CO
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