Basic Information
| Provider Information | |||||||||
| NPI: | 1023135597 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH PARK MEDICAL CLINIC, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH PARK MEDICAL CLINIC, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 686 | ||||||||
| Address2: | |||||||||
| City: | WALDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804800686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707234255 | ||||||||
| FaxNumber: | 9707234268 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 MCKINLEY STREET | ||||||||
| Address2: | |||||||||
| City: | WALDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707234255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 04/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | LARSEN | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINIC MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9707234255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.