Individual
CLINT B PITCHFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1501 E 3RD ST, DELTA, CO 81416-2815
(970) 874-7681
(970) 874-6400
Mailing address
PO BOX 10100, DELTA, CO 81416-0008
(970) 874-7681
(970) 874-6400
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
100093
CO
367500000X
Certified Registered Nurse Anesthetist
250160
AZ
367500000X
Certified Registered Nurse Anesthetist
CRNA-01147
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053603993
—
UT
05
—
25670875
—
CO
05
—
634497
—
AZ
05
—
69837252
—
NM
01
—
NMAAA1472
MEDICARE PTAN
NM
Enumeration date
05/11/2011
Last updated
03/11/2021
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