| Longevity Clinical Ltc Associates Of Colorado Pllc | |
|
12136 W Bayaud Ave Lakewood CO 80228-2115 | |
| (303) 238-3838 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of Colorado Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 12136 W Bayaud Ave, Lakewood, Colorado |
| Authorized Official Name and Position | Diane Vincur (CLINICAL SUPPORT TALENT SPECIALIST) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of Colorado Pllc 11770 Us Highway 1 Ste 102e Palm Beach Gardens FL 33408-3052 Ph: (813) 399-2607 | Longevity Clinical Ltc Associates Of Colorado Pllc 12136 W Bayaud Ave Lakewood CO 80228-2115 Ph: (303) 238-3838 |
| NPI Number | 1972269793 |
|---|---|
| Provider Enumeration Date | 11/16/2021 |
| Last Update Date | 11/16/2021 |
| Medicare PECOS PAC ID | 8325430689 |
|---|---|
| Medicare Enrollment ID | O20220118001206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972269793 | NPI | - | NPPES |
| Provider Name | Kathryn E Bouchard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134351356 PECOS PAC ID: 0840476875 Enrollment ID: I20110509000631 |
| Provider Name | Emmanuela Agwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982062337 PECOS PAC ID: 7416224860 Enrollment ID: I20170606002480 |
| Provider Name | Ambria Repass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073039376 PECOS PAC ID: 0244504470 Enrollment ID: I20170926003633 |
| Provider Name | Krissy Renee Spahr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568734366 PECOS PAC ID: 8729338280 Enrollment ID: I20180904001066 |
| Provider Name | Leah S Ruch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841767837 PECOS PAC ID: 9638416688 Enrollment ID: I20190129001339 |
| Provider Name | Valerie Anne Shade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164088597 PECOS PAC ID: 4486987070 Enrollment ID: I20190613002197 |
| Provider Name | Linnea S. Hord |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518014760 PECOS PAC ID: 9638392061 Enrollment ID: I20220218002280 |
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