Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1400 37th St, Evans, Colorado |
Authorized Official Name and Position | Cathy Wolff (CFO) |
Authorized Official Contact | 9703462546 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2930 11th Ave Evans CO 80620-1011 Ph: () - | 1400 37th St Evans CO 80620-1906 Ph: (970) 353-9403 |
NPI Number | 1811295264 |
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Provider Enumeration Date | 03/09/2011 |
Last Update Date | 05/29/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811295264 | NPI | - | NPPES |
16386761 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |