Healthcare Provider Details

I. General information

NPI: 1821414335
Provider Name (Legal Business Name): PRIMARY CARE PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 KOKOPELLI BLVD UNIT D
FRUITA CO
81521-8723
US

IV. Provider business mailing address

PO BOX 10700
GRAND JUNCTION CO
81502-5517
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-5437
  • Fax: 970-243-7792
Mailing address:
  • Phone: 970-254-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY J CLARK
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 970-254-2642