Healthcare Provider Details

I. General information

NPI: 1245234525
Provider Name (Legal Business Name): PLAINS MEDICAL CENTER, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST ST
LIMON CO
80828-1120
US

IV. Provider business mailing address

PO BOX 1120
LIMON CO
80828-1120
US

V. Phone/Fax

Practice location:
  • Phone: 719-765-4777
  • Fax: 719-765-4357
Mailing address:
  • Phone: 719-775-2367
  • Fax: 719-775-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0677
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0677
License Number StateCO

VIII. Authorized Official

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