| Teller County | |
|
11115 W. Highway 24 Unit 2c Divide CO 80814 | |
| (719) 687-6416 | |
| (719) 687-6501 |
| Full Name | Teller County |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 11115 W. Highway 24, Divide, Colorado |
| Authorized Official Name and Position | Christina Goettge Rubin (DIRECTOR) |
| Authorized Official Contact | 7196876416 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teller County Po Box 928 Divide CO 80814-0928 Ph: (719) 687-6416 | Teller County 11115 W. Highway 24 Unit 2c Divide CO 80814 Ph: (719) 687-6416 |
| NPI Number | 1104998822 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 04/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104998822 | NPI | - | NPPES |
| 04540548 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | 04540548 (Colorado) | Primary |
Peak Vista Community Health Centers Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 Hybrook Rd South, Divide, CO 80814 Phone: 719-632-5700 Fax: 719-687-4457 |