Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 640 Hathaway St, Fairplay, Colorado |
Authorized Official Name and Position | Josh Cogdill (CEO) |
Authorized Official Contact | 9706684040 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 4337 Frisco CO 80443-4337 Ph: (970) 668-4040 | 640 Hathaway St Fairplay CO 80440 Ph: (970) 668-4040 |
NPI Number | 1215422720 |
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Provider Enumeration Date | 06/27/2018 |
Last Update Date | 12/30/2024 |
Medicare PECOS PAC ID | 8022284074 |
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Medicare Enrollment ID | O20181114000858 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215422720 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
South Park Medical Group,pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 824 Castello Street, Fairplay, CO 80440 Phone: 719-836-1900 | |
Salida Hospital District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 525 Hathaway Street, Fairplay, CO 80440 Phone: 719-836-0334 | |