Organization
HERITAGE INTERNAL MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES R STJERNHOLM M.D. (PRESIDENT)
(719) 564-0450
Entity
Organization
Contact information
Practice address
1925 E ORMAN AVE, SUITE A535, PUEBLO, CO 81004-3537
(719) 564-0450
(719) 564-1659
Mailing address
1925 E ORMAN AVE, SUITE A535, PUEBLO, CO 81004-3537
(719) 564-0450
(719) 564-1659
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04021622
—
CO
01
—
CN4621
RAILROAD MEDICARE
CO
Enumeration date
05/21/2007
Last updated
04/29/2008
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