| Marillac Clinic, Inc. | |
|
302 Pitkin Ave Grand Junction CO 81501 | |
| (970) 298-1782 | |
| (970) 298-1711 |
| Full Name | Marillac Clinic, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 302 Pitkin Ave, Grand Junction, Colorado |
| Authorized Official Name and Position | Lata Ramachandran (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9702982235 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marillac Clinic, Inc. 2333 N 6th St Grand Junction CO 81501-2001 Ph: (970) 298-1782 | Marillac Clinic, Inc. 302 Pitkin Ave Grand Junction CO 81501 Ph: (970) 298-1782 |
| NPI Number | 1093163800 |
|---|---|
| Provider Enumeration Date | 06/02/2016 |
| Last Update Date | 09/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093163800 | NPI | - | NPPES |
| 90252365 | Medicaid | CO | |
| 15522865 | Medicaid | CO | |
| 27421767 | Medicaid | CO | |
| 72071362 | Medicaid | CO | |
| 38402068 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 18U295 (Colorado) | Primary |
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