| Wayne Hudson DO Integrated Medical Practice PLLC | |
|
310 E Olive St Lamar CO 81052-2841 | |
| (719) 691-2291 | |
| Not Available |
| Full Name | Wayne Hudson DO Integrated Medical Practice PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 310 E Olive St, Lamar, Colorado |
| Authorized Official Name and Position | Robert Jay Brooke (OWNER/PARTNER) |
| Authorized Official Contact | 7196912291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne Hudson DO Integrated Medical Practice PLLC 310 E Olive St Lamar CO 81052-2841 Ph: (716) 931-9844 | Wayne Hudson DO Integrated Medical Practice PLLC 310 E Olive St Lamar CO 81052-2841 Ph: (719) 691-2291 |
| NPI Number | 1093449415 |
|---|---|
| Provider Enumeration Date | 07/12/2022 |
| Last Update Date | 12/07/2022 |
| Certification Date | 12/07/2022 |
| Medicare PECOS PAC ID | 8921476227 |
|---|---|
| Medicare Enrollment ID | O20221117000786 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093449415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 251S00000X | Community/behavioral Health | () | Secondary |
| Provider Name | John P Abbott |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255477790 PECOS PAC ID: 5496721664 Enrollment ID: I20060410000105 |
| Provider Name | Robert Jay Brooke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669806774 PECOS PAC ID: 3476513474 Enrollment ID: I20221117001184 |
| Provider Name | Sharon K Headrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699922971 PECOS PAC ID: 3971788217 Enrollment ID: I20231013001905 |
| Provider Name | Jodell W Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093442063 PECOS PAC ID: 2769977073 Enrollment ID: I20251223002817 |
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