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General NPI Number Information
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NPI Number | 1588206817
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Entity Type | Organization
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Legal Business Name | WILDERNESS JOURNEYS PAGOSA, INC.
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 135 COUNTRY CENTER DR STE D
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-8958
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Country | US
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Telephone | 970-731-4081
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5076
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-5076
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Country | US
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Telephone | 970-731-4081
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | KEVIN METZLER
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Credential |
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Telephone | 970-731-4081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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