NPIMap

Organization Active NPI

Mountain Medical Center of Buena Vista, PC

  • Family Medicine Physician
  • Buena Vista, CO
National Provider Identifier
1386728640
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOUNTAIN MEDICAL CENTER OF BUENA VISTA, PC
Practice address
36 Oak Street
Buena Vista, CO 81211
Phone
(719) 395-8632
Fax
(719) 395-4971
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2013

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

Authorized official

Name
Thomas E White, M.D.
Title
President
Phone
(719) 395-8632

Specialties & licenses 1

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

Addresses

Primary practice location

36 Oak Street
Buena Vista, CO 81211

Mailing address

PO Box 3129
Buena Vista, CO 81211-3129
Phone (719) 395-8632

Other identifiers 3

IdentifierTypeStateIssuer
05638739MedicaidCO
DF7744OtherRAILROAD MEDICARE
04010187MedicaidCO

Other names 1

  • Mountain Medical Center of Buena Vista, PC Doing business as

National Provider Directory

National Provider Directory

Locations

530 W 16th St
Salida, CO 81201
Phone (303) 751-2000

Practitioners & affiliated clinicians

Practitioners 3

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": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1386728640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3129",
            "city": "BUENA VISTA",
            "state": "CO",
            "postal_code": "812113129",
            "telephone_number": "719-395-8632",
            "fax_number": "719-395-4971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 OAK STREET",
            "city": "BUENA VISTA",
            "state": "CO",
            "postal_code": "81211",
            "telephone_number": "719-395-8632",
            "fax_number": "719-395-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN MEDICAL CENTER OF BUENA VISTA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-395-8632",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638739",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF7744",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04010187",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Medical Center of Buena Vista, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buena Vista, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.