| The Wish Clinic | |
|
10050 Ralston Rd Unit 3 Arvada CO 80004-4974 | |
| (720) 577-4584 | |
| (720) 577-4587 |
| Full Name | The Wish Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 10050 Ralston Rd Unit 3, Arvada, Colorado |
| Authorized Official Name and Position | Traci A. Kimball (OWNER) |
| Authorized Official Contact | 7205576510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wish Clinic 10050 Ralston Rd Unit 3 Arvada CO 80004-4974 Ph: (720) 577-4584 | The Wish Clinic 10050 Ralston Rd Unit 3 Arvada CO 80004-4974 Ph: (720) 577-4584 |
| NPI Number | 1326449646 |
|---|---|
| Provider Enumeration Date | 09/05/2014 |
| Last Update Date | 02/19/2024 |
| Certification Date | 02/19/2024 |
| Medicare PECOS PAC ID | 9739491952 |
|---|---|
| Medicare Enrollment ID | O20150701000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326449646 | NPI | - | NPPES |
| 41180259 | Medicaid | CO |
| Provider Name | Traci Kimball |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841337110 PECOS PAC ID: 0648427344 Enrollment ID: I20120831000571 |
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