| Centura Health Physician Group Tri-lakes Primary Care | |
|
17230 Jackson Creek Pkwy Suite 300 Monument CO 80132-7301 | |
| (719) 571-7000 | |
| (719) 571-7059 |
| Full Name | Centura Health Physician Group Tri-lakes Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 17230 Jackson Creek Pkwy, Monument, Colorado |
| Authorized Official Name and Position | Angela Skinner (OMA ADMINISTRATOR) |
| Authorized Official Contact | 3036737175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centura Health Physician Group Tri-lakes Primary Care Po Box 911057 Denver CO 80291-1057 Ph: (303) 643-1099 | Centura Health Physician Group Tri-lakes Primary Care 17230 Jackson Creek Pkwy Suite 300 Monument CO 80132-7301 Ph: (719) 571-7000 |
| NPI Number | 1497157960 |
|---|---|
| Provider Enumeration Date | 09/16/2014 |
| Last Update Date | 04/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497157960 | NPI | - | NPPES |
| 36258857 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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