Healthcare Provider Details

I. General information

NPI: 1952366593
Provider Name (Legal Business Name): EASTERN PLAINS MEDICAL CLINIC OF CALHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CRYSTOLA ST
CALHAN CO
80808-8699
US

IV. Provider business mailing address

PO BOX 275
CALHAN CO
80808-0275
US

V. Phone/Fax

Practice location:
  • Phone: 719-347-0100
  • Fax: 719-347-0851
Mailing address:
  • Phone: 719-347-0100
  • Fax: 719-347-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENAE LOUISE CRAWFORD
Title or Position: OWNER
Credential: FNP
Phone: 719-347-0100