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THE PAGOSA MEDICAL GROUP LLC
Complete NPI Record 1497473391
Pediatrics in Durango, CO

NPI Status: Active since August 16, 2022

Contact Information

215 E 12TH ST
DURANGO, CO
ZIP 81301
Phone: (970) 372-0456

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Middle Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart
  26. Parent Organization LBN
  27. Parent Organization TIN
  28. Healthcare Provider Taxonomy Group 1
  29. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1497473391. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1497473391
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Entity Type Code: 2
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Employer Identification Number EIN: UNAVAIL
The city name in the mailing address of the provider being identified.
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider First Line Business Mailing Address: 27B TALISMAN DR UNIT 3
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address City Name: PAGOSA SPRINGS
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CO
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 811477914
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address Country Code If outside U S : US
The city name in the location address of the provider being identified.
Provider First Line Business Practice Location Address: 215 E 12TH ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: DURANGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CO
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 813015206
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9703720456
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/16/2022
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/16/2022
The date that a record was last updated or changed.
Authorized Official Last Name: ASH
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: RHONDA
The first name of the authorized official.
Authorized Official Middle Name: L
The middle name of the authorized official.
Authorized Official Title or Position: PRACTICE ADMINISTRATOR
The title or position of the authorized official.
Authorized Official Telephone Number: 9703720456
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 208000000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: Y
Parent Organization LBN: THE PAGOSA MEDICAL GROUP LLC
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 8/16/2022