Provider Demographics
NPI:1154743979
Name:MEDCARE LLC
Entity type:Organization
Organization Name:MEDCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KARGUL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:719-836-0500
Mailing Address - Street 1:PO BOX 7399
Mailing Address - Street 2:PMB#453
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-7399
Mailing Address - Country:US
Mailing Address - Phone:719-836-0500
Mailing Address - Fax:719-836-0515
Practice Address - Street 1:45 FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-0500
Practice Address - Fax:719-836-0515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-14
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0184663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1093070344OtherMEDICARE NPI
CO1093070344OtherMEDCARE LLC
CO1669498838OtherJOANN KARGUL
CO1669498838OtherJOANN KARGUL