| Moontower Wellness, Llc | |
|
11705 Airport Way Ste 205 Broomfield CO 80021-2710 | |
| (512) 522-7708 | |
| Not Available |
| Full Name | Moontower Wellness, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11705 Airport Way Ste 205, Broomfield, Colorado |
| Authorized Official Name and Position | William Coleman Weatherby (MEMBER/MANAGER) |
| Authorized Official Contact | 5125227708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moontower Wellness, Llc 11705 Airport Way Ste 205 Broomfield CO 80021-2710 Ph: (512) 522-7708 | Moontower Wellness, Llc 11705 Airport Way Ste 205 Broomfield CO 80021-2710 Ph: (512) 522-7708 |
| NPI Number | 1295092252 |
|---|---|
| Provider Enumeration Date | 04/16/2012 |
| Last Update Date | 05/09/2024 |
| Certification Date | 05/09/2024 |
| Medicare PECOS PAC ID | 7618125295 |
|---|---|
| Medicare Enrollment ID | O20120925000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295092252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | N6094 (Texas) | Primary |
| Provider Name | William C Weatherby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306007604 PECOS PAC ID: 8921284316 Enrollment ID: I20110519000507 |
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