MEDICARE: CRESTED BUTTE MEDICAL CENTER PLLC

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	261QU0200X	Urgent Care Clinic/Center	30833	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	:	1588838023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTED BUTTE MEDICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1850
Second Line	:
City	:	CRESTED BUTTE
State	:	CO
Zip	:	81224-1850
Country	:	US
Telephone Number	:	970-349-0321
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 SNOWMASS RD
Second Line	:	SUITE 1
City	:	MT. CRESTED BUTTE
State	:	CO
Zip	:	81225
Country	:	US
Telephone Number	:	970-349-0321
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PATTI KAECH
Credential	:
Telephone Number	:	970-349-0321

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	09/15/2011

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