| Edward M. Kennedy Health Clinic | |
|
925 2nd Ave Monte Vista CO 81144-1432 | |
| (719) 852-2512 | |
| (719) 852-3923 |
| Full Name | Edward M. Kennedy Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 925 2nd Ave, Monte Vista, Colorado |
| Authorized Official Name and Position | Jania Arnoldi (PRESIDENT/CEO) |
| Authorized Official Contact | 7195895161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward M. Kennedy Health Clinic 128 Market St Alamosa CO 81101-2290 Ph: (719) 587-1001 | Edward M. Kennedy Health Clinic 925 2nd Ave Monte Vista CO 81144-1432 Ph: (719) 852-2512 |
| NPI Number | 1821085994 |
|---|---|
| Provider Enumeration Date | 10/04/2005 |
| Last Update Date | 04/30/2024 |
| Medicare PECOS PAC ID | 5991609067 |
|---|---|
| Medicare Enrollment ID | O20040105000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821085994 | NPI | - | NPPES |
| CE 9669 | Other | CO | TRAVELERS MEDICARE NUMBER |
| VAC 4808 | Other | CO | ANTHEM BCBS |
| 56836074 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |
Richard D. Santi, D.d.s., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Rupert St, Monte Vista, CO 81144 Phone: 719-852-2552 Fax: 719-852-3742 |