Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 186 N Hurt St, Center, Colorado |
Authorized Official Name and Position | Jania Arnoldi (PRESIDENT/CEO) |
Authorized Official Contact | 7195895161 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
128 Market St Alamosa CO 81101-2290 Ph: (719) 587-1001 | 186 N Hurt St Center CO 81125 Ph: (719) 754-2778 |
NPI Number | 1407843576 |
---|---|
Provider Enumeration Date | 10/04/2005 |
Last Update Date | 05/13/2024 |
Medicare PECOS PAC ID | 5991609067 |
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Medicare Enrollment ID | O20040315000384 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407843576 | NPI | - | NPPES |
CE 9669 | Other | CO | TRAVELERS MEDICARE NUMBER |
VAC 4808 | Other | CO | ANTHEM BCBS |
57200882 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |