Provider Demographics
NPI:1629016548
Name:HILTON C RAY MDPC
Entity type:Organization
Organization Name:HILTON C RAY MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HILTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-336-9115
Mailing Address - Street 1:109 LEE AVE
Mailing Address - Street 2:SUITE15
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3717
Mailing Address - Country:US
Mailing Address - Phone:719-336-9115
Mailing Address - Fax:
Practice Address - Street 1:109 LEE AVE
Practice Address - Street 2:SUITE15
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3717
Practice Address - Country:US
Practice Address - Phone:719-336-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27527310Medicaid
CODB5771OtherRAILROAD MEDICARE
COHI40452OtherBLUE SHIELD
CO27527310Medicaid