Provider Demographics
NPI:1659523462
Name:SOUTHWEST COLORADO SPINE AND MUSCULOSKELETAL CENTER, P.C.
Entity Type:Organization
Organization Name:SOUTHWEST COLORADO SPINE AND MUSCULOSKELETAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER / MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEFFI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-382-8292
Mailing Address - Street 1:575 RIVERGATE UNIT 204
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7490
Mailing Address - Country:US
Mailing Address - Phone:970-382-8292
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE UNIT 204
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7490
Practice Address - Country:US
Practice Address - Phone:970-382-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO210090208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty