Provider Demographics
NPI:1679756431
Name:PEDIATRIC ASSOCIATES OF DURANGO, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF DURANGO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:OHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-259-7337
Mailing Address - Street 1:1199 MAIN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5259
Mailing Address - Country:US
Mailing Address - Phone:970-259-7337
Mailing Address - Fax:970-259-7366
Practice Address - Street 1:1199 MAIN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5259
Practice Address - Country:US
Practice Address - Phone:970-259-7337
Practice Address - Fax:970-259-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty