| Colorado Community Clinic Inc | |
|
1605 N Union Blvd Ste 100 Colorado Springs CO 80909 | |
| (719) 390-3150 | |
| (719) 390-3176 |
| Full Name | Colorado Community Clinic Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1605 N Union Blvd Ste 100, Colorado Springs, Colorado |
| Authorized Official Name and Position | Anjana Joshi (ADMINISTRATOR) |
| Authorized Official Contact | 7194392505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colorado Community Clinic Inc Po Box 26566 Colorado Springs CO 80936-6566 Ph: (719) 390-3150 | Colorado Community Clinic Inc 1605 N Union Blvd Ste 100 Colorado Springs CO 80909 Ph: (719) 390-3150 |
| NPI Number | 1548402647 |
|---|---|
| Provider Enumeration Date | 04/03/2009 |
| Last Update Date | 08/16/2018 |
| Medicare PECOS PAC ID | 8921152299 |
|---|---|
| Medicare Enrollment ID | O20090820000646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548402647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Azmi E Farag |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134288277 PECOS PAC ID: 0143273409 Enrollment ID: I20050225000803 |
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