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Family Medicine Clinic

General Practice in Walsenburg, CO. Organization (NPI-2).

NPI number1760675698
StatusActive
Last updated in NPPESSep 20, 2016

Details

NPI
1760675698
Entity type
Organization (NPI-2)
Legal business name
Family Medicine Clinic
Organization subpart
No
Enumeration date
Aug 23, 2007
Last updated
Sep 20, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General Practice27053COYes

Practice location

100 W 4th St
Walsenburg, CO 81089-1910

Phone 719-738-1164 · Fax 719-738-3399

Mailing address

100 W 4th St
Walsenburg, CO 81089-1910

Phone 719-738-1164 · Fax 719-738-3399

Authorized official

C David Neece
Owner/Provider
7197381164

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