Provider Demographics
NPI:1881788537
Name:UNCOMPAHGRE FAMILY MEDICINE PC
Entity type:Organization
Organization Name:UNCOMPAHGRE FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SULLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-252-9165
Mailing Address - Street 1:535 S NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-252-9165
Mailing Address - Fax:970-252-8874
Practice Address - Street 1:535 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-252-9165
Practice Address - Fax:970-252-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39301261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG4940OtherRAILROAD MEDICARE
CO81957823Medicaid
CO452308Medicare ID - Type UnspecifiedGROUP NUMBER
DG4940OtherRAILROAD MEDICARE