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11115 W. Highway 24 Unit 2c Divide CO 80814 | |
(719) 687-6416 | |
(719) 687-6501 |
Full Name | |
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Speciality | Clinic/center - Public Health, State Or Local |
Location | 11115 W. Highway 24, Divide, Colorado |
Authorized Official Name and Position | Christina Goettge Rubin (DIRECTOR) |
Authorized Official Contact | 7196876416 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 928 Divide CO 80814-0928 Ph: (719) 687-6416 | 11115 W. Highway 24 Unit 2c Divide CO 80814 Ph: (719) 687-6416 |
NPI Number | 1104998822 |
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Provider Enumeration Date | 11/15/2006 |
Last Update Date | 04/08/2010 |
Identifier | Type | State | Issuer |
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1104998822 | NPI | - | NPPES |
04540548 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
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261QP0905X | Clinic/center - Public Health, State Or Local | 04540548 (Colorado) | Primary |