Provider Demographics
NPI:1255632907
Name:TOWN CLINIC OF CRESTED BUTTE, PLLC
Entity type:Organization
Organization Name:TOWN CLINIC OF CRESTED BUTTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-319-5631
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:214 6TH ST. SUITE 1
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1546
Mailing Address - Country:US
Mailing Address - Phone:303-319-5631
Mailing Address - Fax:
Practice Address - Street 1:214 6TH ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-1546
Practice Address - Country:US
Practice Address - Phone:303-319-5631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care