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495 W 4th St Dove Creek CO 81324-4900 | |
(970) 677-2291 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 495 W 4th St, Dove Creek, Colorado |
Authorized Official Name and Position | Shelly Burke (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 0000000000 |
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 1328 Durango CO 81302-1328 Ph: (970) 335-2238 | 495 W 4th St Dove Creek CO 81324-4900 Ph: (970) 677-2291 |
NPI Number | 1699301671 |
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Provider Enumeration Date | 03/21/2020 |
Last Update Date | 05/27/2021 |
Medicare PECOS PAC ID | 9133011802 |
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Medicare Enrollment ID | O20200611002589 |
Identifier | Type | State | Issuer |
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1699301671 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |