Organization Active NPI

Cortez Medical Clinic Inc

  • Family Medicine Physician
  • Cortez, CO
National Provider Identifier
1245318757
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30414 Issued in CO
Legal business name
CORTEZ MEDICAL CLINIC INC
Practice address
33 N Elm St
Cortez, CO 81321-3105
Phone
(970) 565-8556
Fax
(970) 564-1134
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shelley Jordan
Title
Office Manager
Phone
(970) 565-8556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 30414 CO Primary

Addresses

Primary practice location

33 N Elm St
Cortez, CO 81321-3105

Mailing address

33 N Elm St
Cortez, CO 81321-3105
Phone (970) 565-8556

Other identifiers 1

IdentifierTypeStateIssuer
04913042MedicaidCO

National Provider Directory

National Provider Directory

Locations

33 N Elm St
Cortez, CO 81321
Phone (970) 565-8556

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245318757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 N ELM ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813213105",
            "telephone_number": "970-565-8556",
            "fax_number": "970-564-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 N ELM ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813213105",
            "telephone_number": "970-565-8556",
            "fax_number": "970-564-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORTEZ MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "970-565-8556"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "30414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04913042",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cortez, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.