Provider Demographics
NPI:1073884318
Name:SECUREMD
Entity Type:Organization
Organization Name:SECUREMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-466-2833
Mailing Address - Street 1:11905 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:MERINO
Mailing Address - State:CO
Mailing Address - Zip Code:80741
Mailing Address - Country:US
Mailing Address - Phone:970-466-2809
Mailing Address - Fax:970-526-1708
Practice Address - Street 1:11905 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:MERINO
Practice Address - State:CO
Practice Address - Zip Code:80741
Practice Address - Country:US
Practice Address - Phone:970-466-2809
Practice Address - Fax:970-526-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28700261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy