Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 308 Main Street, Olathe, Colorado |
Authorized Official Name and Position | Kaye Hotsenpiller (COO) |
Authorized Official Contact | 9703236141 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 529 Olathe CO 81425-0529 Ph: (970) 323-6141 | 308 Main Street Olathe CO 81425 Ph: (970) 323-6141 |
NPI Number | 1770834244 |
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Provider Enumeration Date | 09/25/2012 |
Last Update Date | 12/03/2019 |
Medicare PECOS PAC ID | 5395998744 |
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Medicare Enrollment ID | O20130115000033 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770834244 | NPI | - | NPPES |
061930 | Other | CO | MEDICARE A PTAN |
617703000 | Other | CO | DEPT OF LABOR, OLATHE ONLY |
619803300 | Other | CO | DEPT OF LABOR, MONTROSE ONLY |
294943 | Other | CO | MEDICARE B PTAN |
DU5283 | Other | CO | RAILROAD WORKERS MEDICARE |
OLATHE ONLY: 9890527 | Medicaid | CO |