| Stout Street Clinic - Pharmacy | |
|
2130 Stout Street Denver CO 80205-2827 | |
| (303) 293-3979 | |
| (303) 293-6514 |
| Full Name | Stout Street Clinic - Pharmacy |
|---|---|
| Speciality | Pharmacy |
| Location | 2130 Stout Street, Denver, Colorado |
| Authorized Official Name and Position | Pete J Stoller (CFO) |
| Authorized Official Contact | 3033129606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stout Street Clinic - Pharmacy 2130 Stout Street Denver CO 80205-2827 Ph: (303) 293-3979 | Stout Street Clinic - Pharmacy 2130 Stout Street Denver CO 80205-2827 Ph: (303) 293-3979 |
| NPI Number | 1689857153 |
|---|---|
| Provider Enumeration Date | 12/07/2007 |
| Last Update Date | 10/21/2021 |
| Medicare PECOS PAC ID | 7618958687 |
|---|---|
| Medicare Enrollment ID | O20220720003088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689857153 | NPI | - | NPPES |
| 79000053 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
| 3336C0002X | Pharmacy - Clinic Pharmacy | (* (Not Available)) | Primary |
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