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Ambulatory Health Care Facilities Clinic/Center Public Health, State or Local

Provider NPI: 1174515258

Organization Information:
Organization is Subpart
Authorized Official:  MARK E WALLACE  DIRECTOR  970-304-6410

Practice Location:
1555 N 17TH AVE  GREELEY, CO 80631-9117 US
Tel: 970-304-6410  Fax: 970-304-6412

Business Mailing Address:
1555 N 17TH AVE  GREELEY, CO 80631-9117 US
Tel: 970-304-6410  Fax: 970-304-6412

NPI Information:
NPI: 1174515258
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N261QP0905XAmbulatory Health Care Facilities
Public Health, State or Local
Public Health or Welfare

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 251K00000X





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