Provider Demographics
NPI:1477625556
Name:C T ARCHULETA MD LLC
Entity Type:Organization
Organization Name:C T ARCHULETA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOPE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, LLC
Authorized Official - Phone:719-383-0445
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:2215 SAN JUAN AVE
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1081
Mailing Address - Country:US
Mailing Address - Phone:719-383-0445
Mailing Address - Fax:719-383-0448
Practice Address - Street 1:2215 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1081
Practice Address - Country:US
Practice Address - Phone:719-383-0445
Practice Address - Fax:719-383-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64034763Medicaid
CO64034763Medicaid