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12055 W 2nd Pl Lakewood CO 80228-1506 | |
(303) 360-6276 | |
(303) 789-7222 |
Full Name | |
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Speciality | Clinic/Center |
Location | 12055 W 2nd Pl, Lakewood, Colorado |
Authorized Official Name and Position | April Peer (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 3037611977 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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7495 W 29th Ave Wheat Ridge CO 80033-8002 Ph: (303) 360-6276 | 12055 W 2nd Pl Lakewood CO 80228-1506 Ph: (303) 360-6276 |
NPI Number | 1114213972 |
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Provider Enumeration Date | 06/21/2011 |
Last Update Date | 03/04/2024 |
Medicare PECOS PAC ID | 0648181214 |
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Medicare Enrollment ID | O20120831000686 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114213972 | NPI | - | NPPES |
86602373 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |
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