Provider Demographics
NPI:1154354512
Name:DURANGO URGENT CARE LLC
Entity type:Organization
Organization Name:DURANGO URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-247-8382
Mailing Address - Street 1:2577 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5919
Mailing Address - Country:US
Mailing Address - Phone:970-247-8382
Mailing Address - Fax:970-259-4403
Practice Address - Street 1:2577 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5919
Practice Address - Country:US
Practice Address - Phone:970-247-8382
Practice Address - Fax:970-259-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6720081Medicaid
COE56488Medicare UPIN
COA103501Medicare PIN
COE57321Medicare UPIN
COB67638Medicare UPIN
COS33210Medicare UPIN
COH18383Medicare UPIN
COE93159Medicare UPIN