Healthcare Provider Details

I. General information

NPI: 1083979660
Provider Name (Legal Business Name): PLAINS MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 COMANCHE STREET
KIOWA CO
80117
US

IV. Provider business mailing address

820 1ST STREET
LIMON CO
80828-1120
US

V. Phone/Fax

Practice location:
  • Phone: 720-389-9763
  • Fax: 720-328-0912
Mailing address:
  • Phone: 719-775-2367
  • Fax: 719-775-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MORGAN G HONEA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 719-775-2367