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495 W 4th St Dove Creek CO 81324-0576 | |
(970) 677-2291 | |
(970) 677-2540 |
Full Name | |
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Speciality | Clinic/Center |
Location | 495 W 4th St, Dove Creek, Colorado |
Authorized Official Name and Position | Dianne Smith (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 9706772291 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 576 Dove Creek CO 81324-0576 Ph: (970) 677-2291 | 495 W 4th St Dove Creek CO 81324-0576 Ph: (970) 677-2291 |
NPI Number | 1710954433 |
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Provider Enumeration Date | 03/01/2006 |
Last Update Date | 05/30/2012 |
Medicare PECOS PAC ID | 7517959877 |
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Medicare Enrollment ID | O20100604000367 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710954433 | NPI | - | NPPES |
05682000 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0589 (Colorado) | Primary |