| South Pointe Occupational Medicine And Family Practice Llc | |
|
150 Old Laramie Trail Suite 210 Lafayette CO 80026-7085 | |
| (970) 351-3030 | |
| Not Available |
| Full Name | South Pointe Occupational Medicine And Family Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 150 Old Laramie Trail, Lafayette, Colorado |
| Authorized Official Name and Position | Tara Campbell (MANAGER) |
| Authorized Official Contact | 9703512412 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Pointe Occupational Medicine And Family Practice Llc 150 Old Laramie Trail Suite 210 Lafayette CO 80026-7085 Ph: (970) 351-3030 | South Pointe Occupational Medicine And Family Practice Llc 150 Old Laramie Trail Suite 210 Lafayette CO 80026-7085 Ph: (970) 351-3030 |
| NPI Number | 1396052544 |
|---|---|
| Provider Enumeration Date | 09/09/2010 |
| Last Update Date | 04/08/2021 |
| Medicare PECOS PAC ID | 1759653207 |
|---|---|
| Medicare Enrollment ID | O20170818001208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396052544 | NPI | - | NPPES |
| 01320688 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 32068 (Colorado) | Primary |
| 261QX0100X | Clinic/center - Occupational Medicine | 32068 (Colorado) | Secondary |
| Provider Name | Ashley Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407100571 PECOS PAC ID: 0648590414 Enrollment ID: I20180928001454 |
| Provider Name | Devin Pinaroc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003314576 PECOS PAC ID: 7416382395 Enrollment ID: I20200123000644 |
| Provider Name | Paul K Branch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033340740 PECOS PAC ID: 0648693960 Enrollment ID: I20200706000725 |
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