1609076843 NPI number — MERCY REGIONAL MEDICAL CENTER OF DURANGO

Table of content: (NPI 1609076843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609076843 NPI number — MERCY REGIONAL MEDICAL CENTER OF DURANGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY REGIONAL MEDICAL CENTER OF DURANGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
URGENT CARE AT DMR - MERCY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609076843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 THREE SPRINGS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-8296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-764-3775
Provider Business Mailing Address Fax Number:
970-764-3789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 PURGATORY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-764-3775
Provider Business Practice Location Address Fax Number:
970-764-3789
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIGNUM
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
970-247-4311

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  0700 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04260048 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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