| Marillac Clinic, Inc | |
|
562 29 Rd Grand Junction CO 81504-8901 | |
| (970) 200-1600 | |
| Not Available |
| Full Name | Marillac Clinic, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 562 29 Rd, Grand Junction, Colorado |
| Authorized Official Name and Position | Lata Ramachandran (CEO) |
| Authorized Official Contact | 9702001629 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marillac Clinic, Inc 2333 N 6th St Grand Junction CO 81501-2001 Ph: (970) 200-1600 | Marillac Clinic, Inc 562 29 Rd Grand Junction CO 81504-8901 Ph: (970) 200-1600 |
| NPI Number | 1902471295 |
|---|---|
| Provider Enumeration Date | 05/20/2021 |
| Last Update Date | 05/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902471295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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