Plateau Valley Medical Clinic | |
58128 Highway 330 Collbran CO 81624-9502 | |
(970) 487-3565 | |
Not Available |
Full Name | Plateau Valley Medical Clinic |
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Speciality | Family Medicine |
Location | 58128 Highway 330, Collbran, Colorado |
Authorized Official Name and Position | Jessie Clark (ADMINISTRATOR) |
Authorized Official Contact | 9704873565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Plateau Valley Medical Clinic 58128 Highway 330 Collbran CO 81624-9502 Ph: (970) 487-3565 | Plateau Valley Medical Clinic 58128 Highway 330 Collbran CO 81624-9502 Ph: (970) 487-3565 |
NPI Number | 1609990928 |
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Provider Enumeration Date | 03/19/2007 |
Last Update Date | 06/07/2022 |
Medicare PECOS PAC ID | 1658365879 |
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Medicare Enrollment ID | O20040412000825 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609990928 | NPI | - | NPPES |
04703047 | Medicaid | CO | |
PLR3408 | Other | CO | BLUE CROSS BLUE SHIELD |
04703047 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Erika Woodyard |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1114075587 PECOS PAC ID: 3072771666 Enrollment ID: I20120229000287 |
Provider Name | Beth Lynn Hedstrom |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306407168 PECOS PAC ID: 6507274701 Enrollment ID: I20210427001882 |