| Little Poudre Family Clinic, Llc | |
|
3817 W County Road 54g Laporte CO 80535-9360 | |
| (970) 472-2001 | |
| (970) 212-9336 |
| Full Name | Little Poudre Family Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3817 W County Road 54g, Laporte, Colorado |
| Authorized Official Name and Position | Karen A Mcgraw (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 9704722001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Poudre Family Clinic, Llc 3817 W County Road 54g Laporte CO 80535-9360 Ph: (970) 472-2001 | Little Poudre Family Clinic, Llc 3817 W County Road 54g Laporte CO 80535-9360 Ph: (970) 472-2001 |
| NPI Number | 1336455997 |
|---|---|
| Provider Enumeration Date | 08/20/2010 |
| Last Update Date | 09/22/2011 |
| Medicare PECOS PAC ID | 0840461737 |
|---|---|
| Medicare Enrollment ID | O20110926000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336455997 | NPI | - | NPPES |
| 46455361 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Colorado) | Primary |
| Provider Name | Julie A Devita-bailey |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1194703926 PECOS PAC ID: 2860406170 Enrollment ID: I20060925000621 |
| Provider Name | Karen A Mcgraw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255574398 PECOS PAC ID: 4385831064 Enrollment ID: I20101207000780 |
Little Poudre Family Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3817 W County Rd 54g, Laporte, CO 80535 Phone: 970-472-2001 Fax: 970-295-4119 |