Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 10th And Dahlia, Antonito, Colorado |
Authorized Official Name and Position | Jania Arnoldi (PRESIDENT/CEO) |
Authorized Official Contact | 7195895161 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
128 Market St Alamosa CO 81101-2290 Ph: (719) 587-1001 | 10th And Dahlia Antonito CO 81120 Ph: (719) 376-5426 |
NPI Number | 1508853813 |
---|---|
Provider Enumeration Date | 10/03/2005 |
Last Update Date | 05/13/2024 |
Medicare PECOS PAC ID | 5991609067 |
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Medicare Enrollment ID | O20040105000171 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508853813 | NPI | - | NPPES |
VAC 4808 | Other | CO | ANTHEM BCBS |
75508222 | Medicaid | CO | |
CE 9669 | Other | CO | TRAVELERS MEDICARE NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |
Conejos County Hospital Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 315 Main Street, Antonito, CO 81120 Phone: 719-376-2308 Fax: 719-376-2395 | |