Active Integrated Medicine | |
329 E Platte Ave Fort Morgan CO 80701-3172 | |
(970) 441-1117 | |
Not Available |
Full Name | Active Integrated Medicine |
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Speciality | General Practice |
Location | 329 E Platte Ave, Fort Morgan, Colorado |
Authorized Official Name and Position | Leif Stephens (ADMINISTRATOR) |
Authorized Official Contact | 9704585216 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Active Integrated Medicine 329 E Platte Ave Fort Morgan CO 80701-3172 Ph: (970) 441-1117 | Active Integrated Medicine 329 E Platte Ave Fort Morgan CO 80701-3172 Ph: (970) 441-1117 |
NPI Number | 1174016331 |
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Provider Enumeration Date | 06/12/2018 |
Last Update Date | 02/23/2024 |
Medicare PECOS PAC ID | 4688914526 |
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Medicare Enrollment ID | O20190313000291 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174016331 | NPI | - | NPPES |
1346781846 | Other | CO | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Leif A Stephens |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1770733297 PECOS PAC ID: 5395802870 Enrollment ID: I20090327000278 |
Provider Name | Sandra J Boone |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346781846 PECOS PAC ID: 6507137593 Enrollment ID: I20170809003272 |
Provider Name | Shenae Marcene Kembel |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033747787 PECOS PAC ID: 0446669329 Enrollment ID: I20210505000962 |
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