Provider Demographics
NPI:1386959468
Name:SONAS IMC, INC
Entity type:Organization
Organization Name:SONAS IMC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:970-247-2500
Mailing Address - Street 1:555 S CAMINO DEL RIO
Mailing Address - Street 2:B2
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6826
Mailing Address - Country:US
Mailing Address - Phone:970-247-2500
Mailing Address - Fax:970-247-2505
Practice Address - Street 1:555 S CAMINO DEL RIO
Practice Address - Street 2:B2
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6826
Practice Address - Country:US
Practice Address - Phone:970-247-2500
Practice Address - Fax:970-247-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186468261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101687Medicare UPIN