Full Name | |
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Speciality | Clinic/Center |
Location | 1211 Luther St, Eads, Colorado |
Authorized Official Name and Position | Shannon Dixon (CFO) |
Authorized Official Contact | 7194385401 |
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 817 Eads CO 81036-0817 Ph: (719) 438-2251 | 1211 Luther St Eads CO 81036 Ph: (719) 438-2251 |
NPI Number | 1659464709 |
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Provider Enumeration Date | 10/02/2006 |
Last Update Date | 07/29/2024 |
Medicare PECOS PAC ID | 5698716827 |
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Medicare Enrollment ID | O20050518000829 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659464709 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |