| Mitchell B. Liester, M.d., P.c. | |
|
153 Washington St Ste 103 Monument CO 80132-9181 | |
| (719) 488-0024 | |
| (719) 488-6672 |
| Full Name | Mitchell B. Liester, M.d., P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 153 Washington St Ste 103, Monument, Colorado |
| Authorized Official Name and Position | Mitchell Brent Liester (CHAIRMAN/OWNER) |
| Authorized Official Contact | 7194880024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mitchell B. Liester, M.d., P.c. Po Box 302 153 N. Washington Street, Suite 103 Monument CO 80132-0302 Ph: (719) 488-0024 | Mitchell B. Liester, M.d., P.c. 153 Washington St Ste 103 Monument CO 80132-9181 Ph: (719) 488-0024 |
| NPI Number | 1578758207 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 09/06/2007 |
| Medicare PECOS PAC ID | 6305926189 |
|---|---|
| Medicare Enrollment ID | O20080107000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578758207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 29395 (Colorado) | Primary |
| Provider Name | Mitchell B Liester |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366430605 PECOS PAC ID: 2264520055 Enrollment ID: I20071112000528 |
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