| Health Center At Fountain | |
|
350 Lyckman Drive Fountain CO 80817 | |
| (719) 632-5700 | |
| (719) 322-0776 |
| Full Name | Health Center At Fountain |
|---|---|
| Speciality | Clinic/Center |
| Location | 350 Lyckman Drive, Fountain, 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 Fountain 3205 N Academy Blvd Suite 130 Colorado Springs CO 80917 Ph: (719) 632-5700 | Health Center At Fountain 350 Lyckman Drive Fountain CO 80817 Ph: (719) 632-5700 |
| NPI Number | 1124320106 |
|---|---|
| Provider Enumeration Date | 11/24/2010 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 4688583974 |
|---|---|
| Medicare Enrollment ID | O20060109000882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124320106 | NPI | - | NPPES |
| 05638267 | Medicaid | CO | |
| 90158229 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Davita Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5115 Fontaine Blvd, Fountain, CO 80817 Phone: 719-392-2000 Fax: 719-392-6937 |