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1735 S Public Rd Ste 100 Lafayette CO 80026-7093 | |
(303) 665-9310 | |
(303) 926-0363 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1735 S Public Rd Ste 100, Lafayette, Colorado |
Authorized Official Name and Position | Brian J Johnston (CFO) |
Authorized Official Contact | 3039260625 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1735 S Public Rd Ste 203 Lafayette CO 80026-7093 Ph: (303) 665-3036 | 1735 S Public Rd Ste 100 Lafayette CO 80026-7093 Ph: (303) 665-9310 |
NPI Number | 1831186915 |
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Provider Enumeration Date | 10/04/2005 |
Last Update Date | 10/31/2024 |
Medicare PECOS PAC ID | 7315850484 |
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Medicare Enrollment ID | O20040929000131 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831186915 | NPI | - | NPPES |
05638259 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0556 (Colorado) | Primary |
Banner Greeley Specialists Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 Exempla Cir, Suite 200, Lafayette, CO 80026 Phone: 970-378-4433 | |