Provider Demographics
NPI:1083717219
Name:PEDIATRIC PARTNERS OF THE SOUTHWEST
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ADMINISTRATOR/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-375-0100
Mailing Address - Street 1:810 EAST 3RD ST SUITE #301
Mailing Address - Street 2:PEDIATRIC PARTNERS OF THE SOUTHWEST
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-375-0100
Mailing Address - Fax:970-375-9210
Practice Address - Street 1:810 EAST 3RD ST, SUITE #301
Practice Address - Street 2:PEDIATRIC PARTNERS OF THE SOUTHWEST
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-375-0100
Practice Address - Fax:970-375-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
CO33703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01337039Medicaid
CO40373037Medicaid
CO66033721Medicaid
CO948.84.315Medicaid
CO01361633Medicare ID - Type UnspecifiedARTHUR ZEMACH MD
COE71947Medicare UPIN
COH62885Medicare UPIN
CO948.84.315Medicaid
COF84762Medicare UPIN
CO66033721Medicaid