MEDICARE: FOUR CORNERS OB/GYN

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	174400000X	Specialist		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	:	1861503948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR CORNERS OB/GYN

Provider Business Mailing Address
First Line	:	1 MERCADO ST STE 105
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7311
Country	:	US
Telephone Number	:	970-382-8800
Fax Number	:	970-382-0122

Provider Business Practice Location Address
First Line	:	1 MERCADO ST
Second Line	:	SUITE # 105
City	:	DURANGO
State	:	CO
Zip	:	81301-7300
Country	:	US
Telephone Number	:	970-382-8800
Fax Number	:	970-382-0122

Authorized Official
Title or Position	:	ADMIN. ASSIST
Name	:	RUTH OLBERT
Credential	:
Telephone Number	:	970-382-8800

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/19/2026

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Directions to “FOUR CORNERS OB/GYN ” Practice Location

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