| Compassionate Concierge Physicians - Wound Grafts | |
|
5390 Saint Vrain Rd Longmont CO 80503-9307 | |
| (720) 986-0850 | |
| Not Available |
| Full Name | Compassionate Concierge Physicians - Wound Grafts |
|---|---|
| Speciality | Family Medicine |
| Location | 5390 Saint Vrain Rd, Longmont, Colorado |
| Authorized Official Name and Position | Kirk Ernest Mitchell (OWNER) |
| Authorized Official Contact | 3038599722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Compassionate Concierge Physicians - Wound Grafts 5390 Saint Vrain Rd Longmont CO 80503-9307 Ph: (720) 986-0850 | Compassionate Concierge Physicians - Wound Grafts 5390 Saint Vrain Rd Longmont CO 80503-9307 Ph: (720) 986-0850 |
| NPI Number | 1003452301 |
|---|---|
| Provider Enumeration Date | 11/21/2019 |
| Last Update Date | 08/12/2023 |
| Certification Date | 08/12/2023 |
| Medicare PECOS PAC ID | 4284069378 |
|---|---|
| Medicare Enrollment ID | O20200117001835 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003452301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 363A00000X | Physician Assistant | () | Secondary |
| 363L00000X | Nurse Practitioner | () | Secondary |
| Provider Name | Robert Vander Leest |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528034238 PECOS PAC ID: 5890876346 Enrollment ID: I20100610000360 |
| Provider Name | Kirk Ernest Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811149685 PECOS PAC ID: 7517016264 Enrollment ID: I20110616000049 |
| Provider Name | Alicia Nicole Peacock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811394828 PECOS PAC ID: 8325363401 Enrollment ID: I20160817001485 |
| Provider Name | Kaitlyn Rose Stiles |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982480547 PECOS PAC ID: 1658713839 Enrollment ID: I20240521001079 |
| Provider Name | Jessica Lynn York |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023849973 PECOS PAC ID: 4981144565 Enrollment ID: I20240910002241 |
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