Zickefoose, Mary Susan
Zickefoose, Mary Susan is an sole proprietor health care provider with primary practice located at 571 Taylor Trl , Canon City CO 81212-3600. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Zickefoose, Mary Susan can be contacted via phone (719) 275-6200.Contact Information
Primary practice address
571 Taylor Trl
Canon City CO 81212-3600
Phone: (719) 275-6200
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 41337 | Colorado |
Profile Details
| NPI number | 1972647147 |
|---|---|
| LBN Legal business name | Zickefoose, Mary Susan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 19th, 2007 |
| Last updated | Sep 5th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972647147 | NPPES |
| Colorado | MEDICAID | 97958557 |
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