Provider Demographics
NPI:1447367768
Name:RAGSDALE AND ASSOCIATES, PC
Entity type:Organization
Organization Name:RAGSDALE AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-247-2451
Mailing Address - Street 1:2877 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5936
Mailing Address - Country:US
Mailing Address - Phone:970-247-2451
Mailing Address - Fax:970-247-8746
Practice Address - Street 1:2877 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5936
Practice Address - Country:US
Practice Address - Phone:970-247-2451
Practice Address - Fax:970-247-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01509349Medicaid
NM384033Medicaid
CO01509349Medicaid
COC82146Medicare PIN