MEDICARE: PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.

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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295488146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.

Provider Business Mailing Address
First Line	:	810 E 3RD ST UNIT 301
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-5760
Country	:	US
Telephone Number	:	970-375-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 MAIN AVE
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-4638
Country	:	US
Telephone Number	:	970-375-0100
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	ALEXANDER SCHACKEL
Credential	:
Telephone Number	:	970-375-0100

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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Directions to “PEDIATRIC PARTNERS OF THE SOUTHWEST P.C. ” Practice Location

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