Provider Demographics
NPI:1225032907
Name:LIMON DOCTORS COMMITTEE
Entity Type:Organization
Organization Name:LIMON DOCTORS COMMITTEE
Other - Org Name:PLAINS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-775-2367
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828-1120
Mailing Address - Country:US
Mailing Address - Phone:719-775-2367
Mailing Address - Fax:719-775-2365
Practice Address - Street 1:134 6TH ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:CO
Practice Address - Zip Code:80828-0308
Practice Address - Country:US
Practice Address - Phone:719-775-2367
Practice Address - Fax:719-775-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO061884Medicare Oscar/Certification
COC79604Medicare PIN