Provider Demographics
NPI:1821279274
Name:HIGH MESA FAMILY MEDCINE, P.C.
Entity Type:Organization
Organization Name:HIGH MESA FAMILY MEDCINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:HIGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-560-1389
Mailing Address - Street 1:1423 E MAIN ST
Mailing Address - Street 2:#404
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2931
Mailing Address - Country:US
Mailing Address - Phone:970-560-1389
Mailing Address - Fax:
Practice Address - Street 1:2095 N DOLORES RD
Practice Address - Street 2:SUITE C
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-8924
Practice Address - Country:US
Practice Address - Phone:970-564-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805091Medicare PIN
COG38393Medicare UPIN