| Fusion Functional Wellness | |
|
302 S 9th St Canon City CO 81212-3847 | |
| (719) 458-8050 | |
| Not Available |
| Full Name | Fusion Functional Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 302 S 9th St, Canon City, Colorado |
| Authorized Official Name and Position | Darcy Cole (OWNER) |
| Authorized Official Contact | 9709035244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fusion Functional Wellness 1019 Whipple Ave Canon City CO 81212-2953 Ph: (970) 903-5244 | Fusion Functional Wellness 302 S 9th St Canon City CO 81212-3847 Ph: (719) 458-8050 |
| NPI Number | 1548894090 |
|---|---|
| Provider Enumeration Date | 02/24/2020 |
| Last Update Date | 06/23/2022 |
| Certification Date | 06/23/2022 |
| Medicare PECOS PAC ID | 4082025283 |
|---|---|
| Medicare Enrollment ID | O20201119000331 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548894090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Darcy Cole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962054809 PECOS PAC ID: 5991116196 Enrollment ID: I20201119000412 |
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