| Middle Park Health - Grand Lake Clinic | |
|
301 Marina Drive Grand Lake CO 80447-0000 | |
| (970) 557-6044 | |
| (970) 724-9446 |
| Full Name | Middle Park Health - Grand Lake Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 301 Marina Drive, Grand Lake, Colorado |
| Authorized Official Name and Position | Kelly S Clasen (SR. DIRECTOR, BUSINESS OPERATIONS) |
| Authorized Official Contact | 3076992413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Middle Park Health - Grand Lake Clinic Po Box 399 Kremmling CO 80459-0399 Ph: (970) 724-3171 | Middle Park Health - Grand Lake Clinic 301 Marina Drive Grand Lake CO 80447-0000 Ph: (970) 557-6044 |
| NPI Number | 1740839240 |
|---|---|
| Provider Enumeration Date | 09/06/2019 |
| Last Update Date | 01/25/2021 |
| Medicare PECOS PAC ID | 7517871544 |
|---|---|
| Medicare Enrollment ID | O20200812000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740839240 | NPI | - | NPPES |
| 9000141155 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |