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14644 Highway 159 San Luis CO 81152-5046 | |
(719) 672-3322 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 14644 Highway 159, San Luis, Colorado |
Authorized Official Name and Position | Javier Martinez (CFO) |
Authorized Official Contact | 7195871083 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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128 Market St Alamosa CO 81101-2290 Ph: (719) 587-1001 | 14644 Highway 159 San Luis CO 81152-5046 Ph: (719) 672-3322 |
NPI Number | 1245941582 |
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Provider Enumeration Date | 12/07/2022 |
Last Update Date | 05/10/2024 |
Identifier | Type | State | Issuer |
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1245941582 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |