| Lotusom, Llc | |
|
408 N Main St Ste F Rocky Ford CO 81067-1256 | |
| (719) 423-8834 | |
| (719) 316-2753 |
| Full Name | Lotusom, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 408 N Main St Ste F, Rocky Ford, Colorado |
| Authorized Official Name and Position | Criston Menz (PRESIDENT/PROVIDER) |
| Authorized Official Contact | 7196960910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotusom, Llc 1100 Hopkins Ave Rocky Ford CO 81067-2421 Ph: (719) 696-0910 | Lotusom, Llc 408 N Main St Ste F Rocky Ford CO 81067-1256 Ph: (719) 423-8834 |
| NPI Number | 1477280576 |
|---|---|
| Provider Enumeration Date | 08/08/2022 |
| Last Update Date | 08/08/2022 |
| Certification Date | 08/08/2022 |
| Medicare PECOS PAC ID | 8123401320 |
|---|---|
| Medicare Enrollment ID | O20220822001474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477280576 | NPI | - | NPPES |
| 14671305 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Criston A Menz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609484062 PECOS PAC ID: 9032592233 Enrollment ID: I20220822001605 |
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