| NPI | 1518239219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATA RAMACHANDRAN Executive Director 970-298-2235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CO 18U295) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| 1223G0001X Dentist, General Practice | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2020-09-21 |