Provider Demographics
NPI:1053190793
Name:FISHER MEDICINE
Entity type:Organization
Organization Name:FISHER MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:970-730-3494
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-0603
Mailing Address - Country:US
Mailing Address - Phone:970-730-3494
Mailing Address - Fax:
Practice Address - Street 1:224 GRAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428
Practice Address - Country:US
Practice Address - Phone:970-730-3494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty