Provider Demographics
NPI:1811513880
Name:SILVERTON AND SAN JUAN CO CLINIC
Entity type:Organization
Organization Name:SILVERTON AND SAN JUAN CO CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKERING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-618-3913
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:CO
Mailing Address - Zip Code:81433-0964
Mailing Address - Country:US
Mailing Address - Phone:970-387-5114
Mailing Address - Fax:970-387-5037
Practice Address - Street 1:1315 SNOWDEN STREET
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:CO
Practice Address - Zip Code:81433
Practice Address - Country:US
Practice Address - Phone:970-387-5114
Practice Address - Fax:970-387-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345OtherFREE CLINIC NO INSURANCE BILLING