Leadville Medical Clinic, PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LEADVILLE MEDICAL CLINIC, PC

Practice address

825 W 6TH St
Leadville, CO 80461-2205

Phone

(719) 486-1264

Fax

(719) 486-1286

NPI assigned

Dec 15, 2006

Last updated

Jun 1, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karl Bridge

Title

Business Administrator

Phone

(719) 486-1264

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306886400000",
    "number": "1710049648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 W 6TH ST",
            "city": "LEADVILLE",
            "state": "CO",
            "postal_code": "804612205",
            "telephone_number": "719-486-1264",
            "fax_number": "719-486-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 W 6TH ST",
            "city": "LEADVILLE",
            "state": "CO",
            "postal_code": "804612205",
            "telephone_number": "719-486-1264",
            "fax_number": "719-486-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEADVILLE MEDICAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2011-06-01",
        "status": "A",
        "authorized_official_last_name": "BRIDGE",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "719-486-1264"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake County Government (LAKE COUNTY PUBLIC HEALTH Agency)
• Lake County Government (Lake County Human Services)
• Lake County School District R-1
• Ashley Larson, MASSAGE THERAPIST
• Leadville Dental Center LLC
• Barbara Letourneau
• Elizabeth Levasseur
• Julie M Lewis, RN
• Jessica Dawn Loveless, RBT
• Cynthia Kuehnle Macisaac

• Specialist in Leadville, CO
• Providers in Leadville, CO by specialty
• Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; 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.