MEDICARE: TELLURIDE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0412420001	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0412420001	OTHER	CO	DME PROVIDER #

General Provider Information

NPI Number	:	1225229966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELLURIDE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1229
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-1229
Country	:	US
Telephone Number	:	970-728-3848
Fax Number	:	970-728-3404

Provider Business Practice Location Address
First Line	:	500 W PACIFIC AVE
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-1229
Country	:	US
Telephone Number	:	970-728-3848
Fax Number	:	970-728-3404

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	PAM MCCREEDY
Credential	:
Telephone Number	:	970-369-2311

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	05/28/2020

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Practice Location Address:

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1417921453 — PAUL D KOELLIKER M.D.
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1265466890 — ERIC C JOHNSON CFNP
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500 W. PACIFIC AVE
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1023043825 — DR. SHARON ANN GRUNDY M.D.
Practice Location Address:

500 WEST PACIFIC AVE
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1538181615 — MS. LAURA CATTELL PA-C
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500 W. PACIFIC AVE
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1700923976 — LAURA JEAN RYAN CRNP
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Directions to “TELLURIDE MEDICAL CENTER ” Practice Location

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