| N/a | |
|
400 Benedicta Ave Suite E Trinidad CO 81082-2089 | |
| (719) 845-0627 | |
| (719) 845-0663 |
| Full Name | N/a |
|---|---|
| Speciality | Family Medicine |
| Location | 400 Benedicta Ave, Trinidad, Colorado |
| Authorized Official Name and Position | Robert Carlisle (OWNER) |
| Authorized Official Contact | 7198450627 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 400 Benedicta Ave Suite E Trinidad CO 81082-2089 Ph: (719) 845-0627 | N/a 400 Benedicta Ave Suite E Trinidad CO 81082-2089 Ph: (719) 845-0627 |
| NPI Number | 1144273830 |
|---|---|
| Provider Enumeration Date | 05/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144273830 | NPI | - | NPPES |
| 05638937 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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