MEDICARE: ADOLESCENT HEALTHCARE ASSOCIATES OF COLORADO

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	261QP2300X	Primary Care Clinic/Center	0078099	CO

General Provider Information

NPI Number	:	1790162451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADOLESCENT HEALTHCARE ASSOCIATES OF COLORADO

Provider Business Mailing Address
First Line	:	214 8TH ST
Second Line	:	SUITE 205
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3326
Country	:	US
Telephone Number	:	970-230-9315
Fax Number	:	970-230-9427

Provider Business Practice Location Address
First Line	:	214 8TH ST
Second Line	:	SUITE 205
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3326
Country	:	US
Telephone Number	:	970-230-9315
Fax Number	:	970-230-9427

Authorized Official
Title or Position	:	OWNER AND PROVIDER OF LLC
Name	:	MS. MARGARET JEAN WEAR
Credential	:	MSN FNP-C
Telephone Number	:	970-230-9315

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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