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General NPI Number Information
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NPI Number | 1881788537
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Entity Type | Organization
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Legal Business Name | UNCOMPAHGRE FAMILY MEDICINE PC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 535 S NEVADA AVE
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-252-9165
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Fax | 970-252-8874
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Provider Business Mailing Address
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Address Line | 535 S NEVADA AVE
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-252-9165
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Fax | 970-252-8874
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY WAYNE SULLINGER
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Credential | MD
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Telephone | 970-252-9165
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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 | 39301
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License Number State | CO
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