Provider Demographics
NPI:1285723890
Name:COTTONWOOD HOLISTIC FAMILY HEALTH
Entity type:Organization
Organization Name:COTTONWOOD HOLISTIC FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-259-7171
Mailing Address - Street 1:3600 MAIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4031
Mailing Address - Country:US
Mailing Address - Phone:970-259-7171
Mailing Address - Fax:970-259-7176
Practice Address - Street 1:3600 MAIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4031
Practice Address - Country:US
Practice Address - Phone:970-259-7171
Practice Address - Fax:970-259-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01356062Medicaid
COC804279Medicare PIN