Provider Demographics
NPI:1790925501
Name:OURAY FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:OURAY FAMILY MEDICINE LLC
Other - Org Name:PAVILION FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-249-6670
Mailing Address - Street 1:1804 E PAVILION PL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5795
Mailing Address - Country:US
Mailing Address - Phone:970-249-6670
Mailing Address - Fax:970-252-1372
Practice Address - Street 1:1804 E PAVILION PL
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5795
Practice Address - Country:US
Practice Address - Phone:970-249-6670
Practice Address - Fax:970-252-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89081251Medicaid
DS4766OtherRAILROAD WORKERS MEDICARE
CO89081251Medicaid