MEDICARE: DR. CARL EDWIN BARTECCHI M.D.

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	207R00000X	Internal Medicine Physician	16422	CO

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	:	1457335705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL EDWIN BARTECCHI M.D.

Provider Business Mailing Address
First Line	:	1600 N GRAND AVENUE
Second Line	:	SUITE 150
City	:	PUEBLO
State	:	CO
Zip	:	81003-2755
Country	:	US
Telephone Number	:	719-595-7700
Fax Number	:	719-595-7719

Provider Business Practice Location Address
First Line	:	1600 N GRAND AVENUE
Second Line	:	SUITE 150
City	:	PUEBLO
State	:	CO
Zip	:	81003-2755
Country	:	US
Telephone Number	:	719-595-7700
Fax Number	:	719-595-7719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/04/2012

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