| |
620 Main St, 102, Fairplay, CO 80440-1295 | |
(719) 838-0328 | |
(719) 836-4874 |
Full Name | |
---|---|
Type | Facility |
Speciality | Audiologist |
Location | 620 Main St, Fairplay, Colorado |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1790002483 | NPI | - | NPPES |
07003015 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
231H00000X | Audiologist | AUD20 (Colorado) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 1295, Fairplay, CO 80440-1295 Ph: (719) 838-0328 | 620 Main St, 102, Fairplay, CO 80440-1295 Ph: (719) 838-0328 |
Dr. Kelly Marie Halligan, AUD Audiologist Medicare: Medicare Enrolled Practice Location: 620 Main St, 102, Fairplay, CO 80440 Phone: 719-838-0328 Fax: 719-836-4874 |