Organization
SANGRE DE CRISTO FAMILY PRACTICE ASSOC., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WAYNE BANKER M.D. (PRESIDENT)
(719) 275-8646
Entity
Organization
Contact information
Practice address
712 MACON AVE, CANON CITY, CO 81212-3314
(719) 275-8646
(888) 484-0223
Mailing address
712 MACON AVE, CANON CITY, CO 81212-3314
(719) 275-8646
(888) 484-0223
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
27050
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04119046
—
CO
Enumeration date
03/15/2007
Last updated
01/05/2016
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