| Take Two Health Pc | |
|
2503 Walnut St Ste 200 Boulder CO 80302-5745 | |
| (303) 557-2250 | |
| (303) 325-7688 |
| Full Name | Take Two Health Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2503 Walnut St Ste 200, Boulder, Colorado |
| Authorized Official Name and Position | Leto Quarles (PHYSICIAN CEO) |
| Authorized Official Contact | 3035572250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Take Two Health Pc 417 Pearl St Boulder CO 80302-4930 Ph: (130) 350-26241 | Take Two Health Pc 2503 Walnut St Ste 200 Boulder CO 80302-5745 Ph: (303) 557-2250 |
| NPI Number | 1720503139 |
|---|---|
| Provider Enumeration Date | 08/07/2017 |
| Last Update Date | 08/07/2017 |
| Medicare PECOS PAC ID | 3072870021 |
|---|---|
| Medicare Enrollment ID | O20171129000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720503139 | NPI | - | NPPES |
| 57820511 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | DR-45461 (Colorado) | Primary |
| Provider Name | Leto Quarles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811917883 PECOS PAC ID: 6507896925 Enrollment ID: I20070717000143 |
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