Provider Demographics
NPI:1205179397
Name:C LYNN PARTRIDGE MD LLC
Entity Type:Organization
Organization Name:C LYNN PARTRIDGE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-749-8895
Mailing Address - Street 1:2243 MAIN AVE
Mailing Address - Street 2:STE 4E
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4699
Mailing Address - Country:US
Mailing Address - Phone:970-749-8895
Mailing Address - Fax:970-385-4909
Practice Address - Street 1:2243 MAIN AVE
Practice Address - Street 2:STE 4E
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4699
Practice Address - Country:US
Practice Address - Phone:970-749-8895
Practice Address - Fax:970-385-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20131082321261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF02306Medicare UPIN
COCA4196Medicare PIN