| Front Range Clinic Inc. | |
|
1308 Vivian St Longmont CO 80501-3217 | |
| (303) 834-8809 | |
| Not Available |
| Full Name | Front Range Clinic Inc. |
|---|---|
| Speciality | Family Medicine - Addiction Medicine |
| Location | 1308 Vivian St, Longmont, Colorado |
| Authorized Official Name and Position | Clark Mccoy (PRESIDENT) |
| Authorized Official Contact | 3522147180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Front Range Clinic Inc. 1040 E Elizabeth St Ste C Fort Collins CO 80524-3952 Ph: () - | Front Range Clinic Inc. 1308 Vivian St Longmont CO 80501-3217 Ph: (303) 834-8809 |
| NPI Number | 1104342443 |
|---|---|
| Provider Enumeration Date | 08/18/2017 |
| Last Update Date | 12/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104342443 | NPI | - | NPPES |
| 1598135451 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0054001 (Colorado) | Secondary |
| 207QA0401X | Family Medicine - Addiction Medicine | 0054001 (Colorado) | Primary |
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