| NPI | 1114257177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAPPER O NICCUM Doctor 970-259-0968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CO 5103) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2013-06-20 |