| Health Center At Divide | |
|
34 Hybrook Rd South Divide CO 80814 | |
| (719) 632-5700 | |
| (719) 687-4457 |
| Full Name | Health Center At Divide |
|---|---|
| Speciality | Clinic/Center |
| Location | 34 Hybrook Rd South, Divide, Colorado |
| Authorized Official Name and Position | Ryan Spillane (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7193447135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Health Center At Divide 3205 N Academy Blvd Suite 130 Colorado Springs CO 80917 Ph: (719) 632-5700 | Health Center At Divide 34 Hybrook Rd South Divide CO 80814 Ph: (719) 632-5700 |
| NPI Number | 1609178524 |
|---|---|
| Provider Enumeration Date | 11/29/2010 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 4688583974 |
|---|---|
| Medicare Enrollment ID | O20030311000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609178524 | NPI | - | NPPES |
| 87322323 | Medicaid | CO | |
| 05638267 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |
Teller County Public Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11115 W. Highway 24, Unit 2c, Divide, CO 80814 Phone: 719-687-6416 Fax: 719-687-6501 |