| NPI | 1407211824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY NARVET MCMANUS CFO 719-344-6188 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2018-09-12 |