Provider Demographics
NPI:1720733082
Name:TELLURIDE MEDICAL CENTER-PRIMARY CARE
Entity Type:Organization
Organization Name:TELLURIDE MEDICAL CENTER-PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-260-0476
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-1229
Mailing Address - Country:US
Mailing Address - Phone:970-728-3848
Mailing Address - Fax:970-728-3404
Practice Address - Street 1:300 SOUTH MAHONEY
Practice Address - Street 2:SUITE C-1
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-3848
Practice Address - Fax:970-728-3404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELLURIDE MEDICAL CENTER - PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-15
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO05338Medicaid