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23400 Us Highway 160 Walsenburg CO 81089-8100 | |
(719) 738-4590 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 23400 Us Highway 160, Walsenburg, Colorado |
Authorized Official Name and Position | Colette C Martin (CFO) |
Authorized Official Contact | 7197385137 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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23500 Us Highway 160 Walsenburg CO 81089-9524 Ph: (719) 738-5144 | 23400 Us Highway 160 Walsenburg CO 81089-8100 Ph: (719) 738-4590 |
NPI Number | 1154799526 |
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Provider Enumeration Date | 09/02/2015 |
Last Update Date | 07/25/2022 |
Medicare PECOS PAC ID | 4789591769 |
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Medicare Enrollment ID | O20110426000426 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154799526 | NPI | - | NPPES |
52007847 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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