| Prairie Clinic Llc | |
|
172 West 1st Springfield CO 81073-8107 | |
| (719) 691-4488 | |
| Not Available |
| Full Name | Prairie Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 172 West 1st, Springfield, Colorado |
| Authorized Official Name and Position | Tennille Ann Rau (LLC MEMBER/MEDICAL PROVIDER) |
| Authorized Official Contact | 7196914642 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Clinic Llc 172 West 1st Springfield CO 81073-9716 Ph: (719) 691-4488 | Prairie Clinic Llc 172 West 1st Springfield CO 81073-8107 Ph: (719) 691-4488 |
| NPI Number | 1740992676 |
|---|---|
| Provider Enumeration Date | 12/22/2022 |
| Last Update Date | 10/19/2023 |
| Medicare PECOS PAC ID | 5698122455 |
|---|---|
| Medicare Enrollment ID | O20231115003925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740992676 | NPI | - | NPPES |
| 1114384138 | Other | CO | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jenna S Homsher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659767853 PECOS PAC ID: 4284941006 Enrollment ID: I20151216000927 |
| Provider Name | Tennille A Rau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114384138 PECOS PAC ID: 7810294980 Enrollment ID: I20160405001202 |
Southeast Colorado Hospital District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 900 Church St, Springfield, CO 81073 Phone: 719-523-6628 Fax: 719-523-4513 | |
Valley-wide Counseling & Support Center - Springfield Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 189 E 9th Ave, Springfield, CO 81073 Phone: 800-511-5446 |