| Edward M Kennedy Health Dental Clinic | |
|
925 2nd Ave Monte Vista CO 81144-1432 | |
| (719) 852-4533 | |
| (719) 852-6134 |
| Full Name | Edward M Kennedy Health Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 925 2nd Ave, Monte Vista, Colorado |
| Authorized Official Name and Position | Jania Arnoldi (PRESIDENT/CEO) |
| Authorized Official Contact | 7195895161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward M Kennedy Health Dental Clinic 128 Market St Alamosa CO 81101-2290 Ph: (719) 589-5161 | Edward M Kennedy Health Dental Clinic 925 2nd Ave Monte Vista CO 81144-1432 Ph: (719) 852-4533 |
| NPI Number | 1629335583 |
|---|---|
| Provider Enumeration Date | 04/17/2012 |
| Last Update Date | 02/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629335583 | NPI | - | NPPES |
| 56836074 | Medicaid | CO | |
| 05638200 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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