| Ten Mile Health & Wellness Llc | |
|
114 Village Place St 207 Dillon CO 80435 | |
| (970) 455-9004 | |
| (949) 577-4247 |
| Full Name | Ten Mile Health & Wellness Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 114 Village Place, Dillon, Colorado |
| Authorized Official Name and Position | Theresa Larkin Clark (PRESIDENT) |
| Authorized Official Contact | 9704559004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ten Mile Health & Wellness Llc Po Box 2098 Dillon CO 80435-2098 Ph: (970) 455-9004 | Ten Mile Health & Wellness Llc 114 Village Place St 207 Dillon CO 80435 Ph: (970) 455-9004 |
| NPI Number | 1417538281 |
|---|---|
| Provider Enumeration Date | 04/14/2021 |
| Last Update Date | 04/14/2021 |
| Certification Date | 04/14/2021 |
| Medicare PECOS PAC ID | 9032528393 |
|---|---|
| Medicare Enrollment ID | O20210518000039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417538281 | NPI | - | NPPES |
| 9000169353 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Theresa L Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104015155 PECOS PAC ID: 2062680010 Enrollment ID: I20190501000062 |
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