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615 West 5th North Cheyenne Wells CO 80810 | |
(719) 767-5661 | |
(719) 767-8042 |
Full Name | |
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Speciality | Clinic/Center |
Location | 615 West 5th North, Cheyenne Wells, Colorado |
Authorized Official Name and Position | Mark Rossi (CEO) |
Authorized Official Contact | 7197675661 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 578 Cheyenne Wells CO 80810-0578 Ph: (719) 767-5661 | 615 West 5th North Cheyenne Wells CO 80810 Ph: (719) 767-5661 |
NPI Number | 1396143574 |
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Provider Enumeration Date | 12/19/2014 |
Last Update Date | 07/12/2022 |
Medicare PECOS PAC ID | 8325364441 |
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Medicare Enrollment ID | O20150402000608 |
Identifier | Type | State | Issuer |
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1396143574 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |