Organization
MOUNTAIN MEDICAL CENTER OF BUENA VISTA, PC
Active
Other names
Mountain Medical Center of Buena Vista, PC
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS E WHITE M.D. (PRESIDENT)
(719) 395-8632
Entity
Organization
Contact information
Practice address
36 OAK STREET, BUENA VISTA, CO 81211
(719) 395-8632
(719) 395-4971
Mailing address
PO BOX 3129, BUENA VISTA, CO 81211-3129
(719) 395-8632
(719) 395-4971
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04010187
—
CO
05
—
05638739
—
CO
01
—
DF7744
RAILROAD MEDICARE
—
Enumeration date
10/24/2006
Last updated
05/14/2013
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