| Ft. Lyon | |
|
30999 County Road 15 Bldg 5 Las Animas CO 81054-9499 | |
| (719) 662-1100 | |
| Not Available |
| Full Name | Ft. Lyon |
|---|---|
| Speciality | Clinic/Center |
| Location | 30999 County Road 15 Bldg 5, Las Animas, Colorado |
| Authorized Official Name and Position | Pete J Stoller (CFO) |
| Authorized Official Contact | 3033129606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ft. Lyon 2111 Champa St Denver CO 80205-2529 Ph: (303) 293-2217 | Ft. Lyon 30999 County Road 15 Bldg 5 Las Animas CO 81054-9499 Ph: (719) 662-1100 |
| NPI Number | 1336563014 |
|---|---|
| Provider Enumeration Date | 02/14/2014 |
| Last Update Date | 10/06/2021 |
| Medicare PECOS PAC ID | 7618958687 |
|---|---|
| Medicare Enrollment ID | O20150211000212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336563014 | NPI | - | NPPES |
| 97238571 | Medicaid | CO | |
| 061952 | Other | CO | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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