Organization
MOUNTAIN MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL THOMAS GATES MD (OWNER)
(970) 626-5123
Entity
Organization
Contact information
Practice address
295 SHERMAN ST, RIDGWAY, CO 81432-0298
(970) 626-5123
(970) 626-9783
Mailing address
PO BOX 298, RIDGWAY, CO 81432-0298
(970) 626-5123
(970) 626-9783
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35376
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12330787
—
CO
01
—
642998
BLUE CROSS BLUE SHIELD
CO
Enumeration date
03/08/2006
Last updated
01/26/2010
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