Full Name | |
---|---|
Speciality | Clinic/center |
Location | 302 Main St, Wiley, Colorado |
Authorized Official Name and Position | Shannon Dixon (CFO) |
Authorized Official Contact | 7194385401 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 99 Wiley CO 81092-0099 Ph: (719) 829-4627 | 302 Main St Wiley CO 81092 Ph: (719) 829-4627 |
NPI Number | 1134139504 |
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Provider Enumeration Date | 08/09/2006 |
Last Update Date | 06/11/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134139504 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |