Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 302 Main, Wiley, Colorado |
Authorized Official Name and Position | Robert Jay Brooke (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7193360261 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
201 Kendall Dr Lamar CO 81052-3939 Ph: (719) 336-0261 | 302 Main Wiley CO 81092 Ph: (719) 829-4286 |
NPI Number | 1912349465 |
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Provider Enumeration Date | 07/25/2013 |
Last Update Date | 04/15/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912349465 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |