| |
1860 E Egbert St Brighton CO 80601-2404 | |
(303) 697-2583 | |
(303) 655-1994 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1860 E Egbert St, Brighton, Colorado |
Authorized Official Name and Position | John Santistevan (DIRECTOR OF FINANCE AND ACCOUNTING) |
Authorized Official Contact | 3038926401 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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203 S Rollie Ave Fort Lupton CO 80621-1508 Ph: (303) 286-4560 | 1860 E Egbert St Brighton CO 80601-2404 Ph: (303) 697-2583 |
NPI Number | 1780717579 |
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Provider Enumeration Date | 03/13/2007 |
Last Update Date | 01/25/2023 |
Medicare PECOS PAC ID | 3173433398 |
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Medicare Enrollment ID | O20100602000586 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780717579 | NPI | - | NPPES |
05638366 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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