Healthcare Provider Details

I. General information

NPI: 1508897117
Provider Name (Legal Business Name): EASTERN PLAINS MEDICAL CLINIC OF CALHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CRYSTOLA STREET
CALHAN CO
80808
US

IV. Provider business mailing address

PO BOX 275
CALHAN CO
80808-0275
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: MRS. KELLI ZEARING
Title or Position: PRACTICE MANAGER
Credential: BSHM, RMA, CMAS
Phone: 719-347-0100