Full Name | |
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Speciality | Clinic/Center |
Location | 410 West Colorado, Holly, Colorado |
Authorized Official Name and Position | Gene Sobczak (CEO) |
Authorized Official Contact | 7193360261 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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201 Kendall Dr Lamar CO 81052-3939 Ph: (719) 336-0261 | 410 West Colorado Holly CO 81047 Ph: (719) 336-0261 |
NPI Number | 1932596350 |
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Provider Enumeration Date | 04/23/2015 |
Last Update Date | 09/04/2024 |
Medicare PECOS PAC ID | 8527031533 |
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Medicare Enrollment ID | O20150805008802 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932596350 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |