Healthcare Provider Details

I. General information

NPI: 1396791646
Provider Name (Legal Business Name): FORT MORGAN MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 9TH AVE
FORT MORGAN CO
80701-2012
US

IV. Provider business mailing address

102 W 9TH AVE
FORT MORGAN CO
80701-2012
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-5681
  • Fax: 970-867-7361
Mailing address:
  • Phone: 970-867-5681
  • Fax: 970-867-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA HEPWORTH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 970-867-5681