Provider Demographics
NPI:1407881139
Name:PAGOSA WOMENS HEALTH AND WELLNESS INC.
Entity Type:Organization
Organization Name:PAGOSA WOMENS HEALTH AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KUHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-264-2218
Mailing Address - Street 1:P O BOX 4522
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81157-4522
Mailing Address - Country:US
Mailing Address - Phone:970-264-2218
Mailing Address - Fax:970-264-2219
Practice Address - Street 1:103 PAGOSA ST
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-264-2218
Practice Address - Fax:970-264-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75528261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service