Healthcare Provider Details

I. General information

NPI: 1215050489
Provider Name (Legal Business Name): NORTH FORK MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MINNESOTA AVE
PAONIA CO
81428
US

IV. Provider business mailing address

PO BOX 47
PAONIA CO
81428-0047
US

V. Phone/Fax

Practice location:
  • Phone: 970-527-4103
  • Fax: 970-527-5171
Mailing address:
  • Phone: 970-527-4103
  • Fax: 970-527-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY C. MEILNER
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: MD
Phone: 970-527-4103