Pediatric Partners of the Southwest P.C.
Organization Active NPI Pediatrics Physician · Durango, CO
NPI 1295488146 · NPPES record last updated Feb 1, 2022
Key facts
- NPI
- 1295488146
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.
- Practice address
- 2390 Main Ave
Durango, CO 81301-4638 - Phone
- (970) 375-0100
- NPI assigned
- Feb 1, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.
Authorized official
- Name
- Alexander Schackel
- Title
- Practice Administrator
- Phone
- (970) 375-0100
Corporate family (same tax ID) 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2165966 | Pediatric Partners of the Southwest | Certificate of waiver | May 7, 2027 |
National Provider Directory
- Tax ID family
- Ped Prtnrs of the SW
- Part of
- Ped Prtnrs of the SW
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
2390 Main Ave
Durango, CO 81301-4638
Mailing address
810 E 3Rd St Unit 301
Durango, CO 81301-5760
Phone (970) 375-0100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 948843159 | Medicaid | CO |
Other names
- Pediatric Partners of the Southwest P.C.
Other providers in Durango, CO
- Lorraine Burson Pearson
- Jane C Pedersen
- Pediatric Associates of Durango, Inc
- Pediatric Partners of the Southwest
- Pediatric Partners of the Southwest
- Sharon Dianne Pellegrom
- Pencechiropractic
- Chari Jean Perce
- Loscar Numael Perez
- Performance Cardiology PC
All providers in Durango, CO · Pediatrics Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.