MEDICARE: INNERHEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1053390336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNERHEALTH LLC

Provider Business Mailing Address
First Line	:	1017 ROBERTSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3926
Country	:	US
Telephone Number	:	970-472-5000
Fax Number	:	970-490-6161

Provider Business Practice Location Address
First Line	:	1017 ROBERTSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3926
Country	:	US
Telephone Number	:	970-472-5000
Fax Number	:	970-490-6161

Authorized Official
Title or Position	:	PARTNER
Name	:	ELIZABETH SWENSON
Credential	:	ACRP
Telephone Number	:	970-472-5000

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/22/2020

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