| Colorado State University | |
|
151 West Lake Street Fort Collins CO 80523-8031 | |
| (970) 491-7121 | |
| (970) 491-6965 |
| Full Name | Colorado State University |
|---|---|
| Speciality | Clinic/center |
| Location | 151 West Lake Street, Fort Collins, Colorado |
| Authorized Official Name and Position | Stephen Blom (DIRECTOR) |
| Authorized Official Contact | 9704911470 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colorado State University 8301 Campus Delivery Fort Collins CO 80523-8031 Ph: (970) 491-7121 | Colorado State University 151 West Lake Street Fort Collins CO 80523-8031 Ph: (970) 491-7121 |
| NPI Number | 1528156437 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 09/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528156437 | NPI | - | NPPES |
| 9000147759 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0832 (Colorado) | Primary |
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