Provider Demographics
NPI:1952468340
Name:DURANGO GYNECOLOGICAL ONCOLOGY PC
Entity Type:Organization
Organization Name:DURANGO GYNECOLOGICAL ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:RITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-259-9052
Mailing Address - Street 1:2243 MAIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4699
Mailing Address - Country:US
Mailing Address - Phone:970-259-9052
Mailing Address - Fax:970-259-0670
Practice Address - Street 1:2243 MAIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4699
Practice Address - Country:US
Practice Address - Phone:970-259-9052
Practice Address - Fax:970-259-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18552207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19653310Medicaid
CODU678598OtherBLUE CROSS OF COLORADO
NM11957Medicaid
CO=========0OtherROCKY MOUNTAIN HEALTH PLAN
COC807546Medicare PIN
COA42938Medicare UPIN