Provider Demographics
NPI:1831231430
Name:AZTEC PRIMARY CARE
Entity type:Organization
Organization Name:AZTEC PRIMARY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-245-6655
Mailing Address - Street 1:2470 F RD
Mailing Address - Street 2:UNIT 10
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1279
Mailing Address - Country:US
Mailing Address - Phone:970-245-6655
Mailing Address - Fax:
Practice Address - Street 1:2470 F RD
Practice Address - Street 2:UNIT 10
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1279
Practice Address - Country:US
Practice Address - Phone:970-245-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO371608Medicare ID - Type Unspecified