Provider Demographics
NPI:1295356996
Name:CHILD WELLNESS CENTER OF THE SOUTHWEST
Entity Type:Organization
Organization Name:CHILD WELLNESS CENTER OF THE SOUTHWEST
Other - Org Name:MCMILLAN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-799-5811
Mailing Address - Street 1:10 TOWN PLZ # 237
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5104
Mailing Address - Country:US
Mailing Address - Phone:970-799-5811
Mailing Address - Fax:970-797-6460
Practice Address - Street 1:215 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5206
Practice Address - Country:US
Practice Address - Phone:970-799-5811
Practice Address - Fax:970-797-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care