Healthcare Provider Details

I. General information

NPI: 1528064714
Provider Name (Legal Business Name): GENERATIONS HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 LINCOLN ST
FORT MORGAN CO
80701-3266
US

IV. Provider business mailing address

931 LINCOLN ST
FORT MORGAN CO
80701-3266
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-1900
  • Fax: 970-867-1931
Mailing address:
  • Phone: 970-867-1900
  • Fax: 970-867-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36467
License Number StateCO

VIII. Authorized Official

Name: DR. SHAUN PATRICK THOMPSON
Title or Position: OWNER
Credential: M.D.
Phone: 970-867-1900