| |
300 Main Street Oak Creek CO 80467 | |
(970) 824-8000 | |
(970) 824-1179 |
Full Name | |
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Speciality | Clinic/Center |
Location | 300 Main Street, Oak Creek, Colorado |
Authorized Official Name and Position | Matt Morrill (CFO) |
Authorized Official Contact | 9708717635 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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745 Russell St Craig CO 81625-2019 Ph: (970) 824-8233 | 300 Main Street Oak Creek CO 80467 Ph: (970) 824-8000 |
NPI Number | 1225528151 |
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Provider Enumeration Date | 05/16/2018 |
Last Update Date | 06/17/2022 |
Medicare PECOS PAC ID | 3173617883 |
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Medicare Enrollment ID | O20210615002953 |
Identifier | Type | State | Issuer |
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1225528151 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |