DR. VINCE J STACK (NPI# 1497706071) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497706071 |
| Entity Type | Individual |
| Full Name | DR. VINCE J STACK |
| Credential | M.D. |
| Practice Address |
905 Harding Ave Canon City CO 81212-2147 |
| Mailing Address |
Po Box 2153 Dept 40339 Birmingham AL 35287-9387 |
| Practice Telephone | 7192754106 |
| Mailing Telephone | 4233101642 |
| Mailing Fax Number | 7062700487 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-06-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 46814 | CO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 45604771 | 05 |
| Street Address |
905 HARDING AVE |
| City | CANON CITY |
| State | CO |
| Zip Code | 81212-2147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366801979 | Kehly Ann Stone | Counselor | 905 Harding Ave, Canon City, CO 81212-2147 | 2016-02-11 |
| 1538378211 | Jonathan Thornton | Occupational Therapist | 905 Harding Ave, Canon City, CO 81212-2147 | 2007-05-21 |
| 1366450090 | Colorado Medical Investors, LLC | Respite Care | 905 Harding Ave, Canon City, CO 81212-2147 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083212393 | Buck Jack LLC | Physical Therapist | Mountain View Core Knowledge School 890 Field Ave, Cannon City, CO 81212 | 2020-10-09 |
| 1942841374 | Glorious Works Neurotherapy | Community/Behavioral Health | 115 N 7th Street, Canon City, CO 81212 | 2019-10-07 |
| 1376046292 | Lonnie Mccarron | Social Worker | 600 Evans Rd, Fremont Correctional Facility, Canon City, CO 81212 | 2018-03-16 |
| 1487156964 | Patrick Neil Cox | Case Manager/Care Coordinator | 3239 Independence Road, Canon City, CO 81212 | 2018-03-01 |
| 1831559806 | Justin Ensinger | Counselor | 700 Four Mile Parkway, Canon City, CO 81212 | 2016-03-03 |
| 1710365713 | Amber Conover | Health Educator | 105 N 10th Street, Canon City, CO 81212 | 2015-05-11 |
| 1902073448 | Richard R Williams | Counselor | 612 Field Ave, Canon City, CO 81212 | 2008-05-14 |
| 1861662249 | Huh Inc | Hearing Instrument Specialist | 121 Justice Center Rd Ste D, Canon City, CO 81212 | 2008-03-03 |
| 1013113828 | Deborah Eileen Shock | Nurse Practitioner | 275 W Hwy 50, Canon City, CO 81212 | 2007-06-27 |
| 1245433564 | Lindsey Elizabeth Fish | Internal Medicine | 275 West Hwy 50, Colorado Territorial Correctional Facility, Canon City, CO 81212 | 2007-06-06 |
| Find all providers in zip 81212 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144694779 | Paladina Health, LLC | Family Medicine | 109 Latigo Ln Ste B, Canon City, CO 81212-8113 | 2015-11-19 |
| 1972647147 | Mary Susan Zickefoose | Family Medicine | 571 Taylor Trl, Canon City, CO 81212-3600 | 2007-02-19 |
| 1699848648 | Michael Wayne Banker | Family Medicine | 712 Macon Ave, Canon City, CO 81212-3314 | 2006-11-16 |
| 1659481836 | Gary Alan Mohr | Family Medicine | 730 Macon Ave, Canon City, CO 81212-3314 | 2006-08-30 |
| 1417925926 | Marc A Sindler | Family Medicine | 215 N 5th St, Canon City, CO 81212-3216 | 2006-03-09 |
| 1396740221 | Kern Low | Family Medicine | 1335 Phay Ave Ste A, Canon City, CO 81212-2349 | 2005-06-16 |
| 1518578129 | Catholic Health Initiatives Colorado | Family Medicine | 1338 Phay Ave Bldg D, Canon City, CO 81212-2326 | 2020-08-17 |
| 1013540921 | Diana Maria Clouthier | Family Medicine | 715 S 9th St, Canon City, CO 81212-4911 | 2020-02-19 |
| 1649651159 | Jason Pfaffly | Family Medicine | 1338 Phay Ave Bldg D, Canon City, CO 81212 | 2015-06-11 |
| 1457615189 | Breanna Rene Berry | Family Medicine | 1338 Phay Ave Bldg D, Canon City, CO 81212-2326 | 2012-06-27 |
| Find all providers in CANON CITY | ||||
| City | CANON CITY |
| Zip Code | 81212 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.