| NPI | 1992850689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY MADIGAN Revenue Manager 719-466-8777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251T00000X PACE Provider Organization |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2024-10-07 |