Healthcare Provider Details

I. General information

NPI: 1306620075
Provider Name (Legal Business Name): NORTHEAST COLORADO FAMILY MEDICINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S 3RD AVE
STERLING CO
80751-4650
US

IV. Provider business mailing address

1405 S 8TH AVE STE 103
STERLING CO
80751-4560
US

V. Phone/Fax

Practice location:
  • Phone: 970-740-3304
  • Fax:
Mailing address:
  • Phone: 970-740-3304
  • Fax: 970-522-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CURTIS CARL CLARK
Title or Position: OWNER
Credential:
Phone: 970-522-1223