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General NPI Number Information
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NPI Number | 1619165958
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MEDICAL CENTER OF BRECKENRIDGE, PC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 1790 AIRPORT ROAD UNIT 2
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-8539
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Country | US
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Telephone | 970-453-7600
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Fax | 970-453-7688
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Provider Business Mailing Address
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Address Line | PO BOX 8539 1790 B AIRPORT RD
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-8539
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Country | US
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Telephone | 970-453-7600
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Fax | 970-453-7688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHARI J FITZGERALD
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Credential | MD
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Telephone | 970-453-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 26641
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License Number State | CO
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